CIGNA Behavioral Health Practitioner Connection – Tips for Completing CMS1500 form

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CBH Practitioner Conection
Volume XXIII, 3rd Quarter

The right help at the right time!

Tips for Completing CMS1500 form

Claim submission can be a confusing process. Understanding how to fill out claim forms can help save time and speed the return of a response from CIGNA Behavioral Health (CBH). As a participating practitioner, you may submit claims through CBH’s website at www.CIGNABehavioral.com (select “Are you a Provider?”). If paper submission is used, the following tips can help ensure that you complete the CMS1500 claim form with all the information needed for the claim to process:

Make sure that the form is filled out in its entirety. Typed forms are easiest to read. In addition, please align information appropriately in each box.
The subscriber ID (Social Security [SSN] or Alternative Member Identification [AMI]) number is required, as well as subscriber first and last name, date of birth and address. These pieces of information help to ensure that your patient is correctly identified in our claims system and that his or her confidentiality is maintained.
If the participant has other benefit carriers, box 9 a-d must be filled out completely. If the participant is a new patient or has had a recent change to benefits, attach a Coordination of Benefits (COB) form. A copy of the COB form can be obtained in the Provider Guide found on the CBH website. Also, an Explanation of Benefits (EOB) will be needed if CBH is not the primary carrier.
The participant should sign the form or have signed a release to have authorized release of information and payment to the service provider (boxes 12 and 13). As a participating practitioner, you, rather than the participant, will receive claim payment.
All service dates should include day, month and year. The year of service is important and cannot be taken or assumed from the date of receipt or any other date on the form.
Dates of Service should be listed individually. Date ranges should be divided into individual dates with a CPT code listed for each date. This information helps to ensure that the claim is processed correctly.
Tax Identification Number (box 25) is required. The National Provider Identifier (NPI) can be accepted on the CMS1500. However, the NPI will not replace the use of the Tax Identification Number.

Including this information on a CMS1500 will help CBH to enter and process the claim. Additional information may be requested or required dependent on the participant’s benefits and any medical necessity information needed. For additional information, please refer to the Provider Guide found under the “Provider Resources” section at www.CIGNABehavioral.com or call the Customer Service number on the participant’s card.