Medical billing turns the patient encounter and supporting documentation into a claim that a payer can evaluate. For professional paper claims, that information is commonly organized on the CMS-1500 form.
Basic workflow
- Verify eligibility, benefits, and whether authorization is required.
- Confirm that the documentation supports the diagnoses, services, units, and modifiers.
- Enter patient, insured, provider, diagnosis, and service-line information.
- Review the claim against the NUCC instructions and payer requirements.
- Print on acceptable form stock, retain a copy, and send it to the correct payer address.
- Track the claim and review the remittance advice or payer response.
Medicare paper claims
Medicare generally requires electronic submission unless an applicable exception is met. Providers using paper should confirm that the claim qualifies and follow the Medicare Administrative Contractor’s instructions.
Billing reminder: Payer and program requirements vary. Confirm the current instructions for the payer receiving the claim.