Help on cms 1500 and hcfa 1500

Management and Administration
1

aterad wrote on Thursday, October 02, 2014:

hello, please i will like to know

  1. What is cms 1500, hcfa 1500, x12 and hl7 (i have read through on google but i seem not to understand any of them). Please simple lay man xplanation.
  2. What can they be used for and how can i use them.
    Thanks in anticipation
2

fsgl wrote on Thursday, October 02, 2014:

The ***C***enter for ***M***edicare and Medicaid ***S***ervices, part of the Department of Health and Human Services, is the federal agency in charge of Medicare & Medicaid. Their previous name was ***H***ealth ***C***are ***F***inance ***A***dministration.

The paper claim form for physician services is the CMS-1500, previously the HCFA-1500. This form is used for Medicare and commercial insurers. Medicaid and Workmen Compensation forms vary by states.

When claims are submitted electronically for physician services, the format is the ANSI X12 5010 837P. After the insurers have processed the claim, the remittance advice is returned in the form of the ANSI X12 5010 835P.

HL7 is used predominately for CCR/CCD & test results in OpenEMR.

3

visolveemr wrote on Friday, October 03, 2014:

CMS and HCFA
The standard insurance claim form used to submit Paper claims

X12 and HL7
These are the EDI(Electronic data interchange) standards, which is an electronic communication system that provides standards for exchanging data via any electronic means.

  • X12 in openemr used to submit the claim through 837P format, and receive payments in 835 format

  • HL7 Health Level Seven, is an medical application standard for exchanging information.

Thanks
OpenEMR Customization/Support Team,
ViSolve Inc
services@visolve.com
Demo’s @ ViSolve Demo Library

4

aterad wrote on Sunday, October 05, 2014:

@fsgl @visolve
thanks for your responses. Yes, i know what the acronysms are,what they stand for but what i dont understand is how to use them.
Take for example the hl7, do i download an hl7 software or reader or what, how do i go about using it. Also cms 1500 which is available in the billing sub-module, whenever i click it, it generates nothing. So am really lost about how to use them. Please kindly put me through. thanks

5

fsgl wrote on Sunday, October 05, 2014:

In order to use the Billing Module, the practice & patient accounts must be set up. See Guide.

See articles about Procedures under Supplementary Topics. This module is used to order & record results of diagnostic studies.

After everything has been set up for a patient in the Summary, go to Report, then CCR/CCD. If the patient transfers to another office, these documents are transmitted to the appropriate office for continuity of care.