Medicaid CMS 1500 important field – critical claim information
CMS-1500 forms may be purchased through HP. Providers may also obtain copies
of the claim form from a printer of their choice. For scanning purposes, these forms
must be printed in the standard CMS format using red dropout ink.
Claims must contain the billing provider’s complete name, address, and NPI.
Critical claim information includes:
• Recipient’s first and last name
• Recipient’s 13-digit Medicaid number
• First two characters of the provider group name
• Payee’s 10-digit NPI
• Rendering (performing) provider’s 10-digit NPI (on each line item)
A claim lacking any of the critical claim information cannot be processed. Also, each
claim form must have a provider signature, initials, a stamped signature, or have an
agreement on file with HP to omit signature requirement.