What is the universal claim form called?

What is the universal claim form called?

• A. Medi-gap
• B. Tricare/ CHAMPUS
• C. CMS-1500
• D. Capitation

Answer: (C)

The standard form used to bill professional, non-institutional medical services is the CMS-1500 form (formerly HCFA-1500). It’s the universal claim form because most payers—Medicare, Medicaid, and many private insurers—accept it under HIPAA, providing a common layout for essential information. This form collects patient and provider details, diagnosis codes (ICD-10-CM), procedure codes (CPT/HCPCS), dates of service, and charges, which enables consistent submission and adjudication across different payer systems. The other options refer to a type of insurance (Medi-gap), a military health program (Tricare/CHAMPUS), or a payment arrangement (capitation), none of which are the universal claim form.

The standard form used to bill professional, non-institutional medical services is the CMS-1500 form (formerly HCFA-1500). It’s the universal claim form because most payers—Medicare, Medicaid, and many private insurers—accept it under HIPAA, providing a common layout for essential information. This form collects patient and provider details, diagnosis codes (ICD-10-CM), procedure codes (CPT/HCPCS), dates of service, and charges, which enables consistent submission and adjudication across different payer systems. The other options refer to a type of insurance (Medi-gap), a military health program (Tricare/CHAMPUS), or a payment arrangement (capitation), none of which are the universal claim form.