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Who developed the Standard Form?


State the name of the insurance form approved by the American Medical Association.

Universal Claim form - CMS-1500 (08-05)

Does Medicare accept the CMS-1500 (08-05) claim form?

Yes. It is required.

What is dual coverage?

When two insurance policies are involved. A primary and a secondary.

The insurance company with the first responsibility for payment of a bill for medical services is known as the.

Primary payer.

What important document must you have before an insurance company can photocopy a patient's chart?

Release of Information Form signed by the patient.

If the patient brings in a private insurance form that is not group insurance, where do you send the form after completion?

To the Insurance Company

An insurance claim is returned for the reason "diagnosis incomplete." State one or more solutions to this problem on how you would try to obtain reimbursement.


When preparing a claim that is to be optically scanned, birth dates are keyed in with how many digits?


Define this abbreviation: MG/MCD


A three-part information form that is completed and signed by an insurance agent and an individual to obtain insurance coverage, and requires a medical examination by a physician is known as:

life or health insurance application

The insurance claim form required when submitting Medicare claims is:

CMS-1500 (08-05) claim form

The maximum number of diagnostic codes in the ANSI 837P claim format for transmitting for transmitting electronic health insurance claim is:


If a patient's gender is not indicated in the CMS-1500 (08-05) claim form, the gender block defaults to:


If a provider or medical services does not have a NPI number, the characters or digits that must be entered in Block 24I is/are:



A photocopy of claim form may be optically scanned.


Handwriting is permitted on optically scanned paper claims.


A CMS-assigned National Provider Identifier (NPI) number consists of 10 characters.


When listing a diagnostic code on an insurance claim, insert the deceimal point.


A diagnosis reference pointer should be entered in Block 24E and not ICD-9-CM diagnostic code.

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