Claims Assignment
Write a 2 page paper about the CMS1500 claim form and the claims submission process.
Include the following:
1. An explanation of what the CMS1500 is and what it is used for.
2. Important dates and events in the creation and revision of the form.
What version of the CMS 1500 became effective 1 October 2014
What were the major revisions on the CMS 1500 (08 05) version
3. A description of the organization that developed the form.
4. A brief explanation of the claims process.
5. Definitions of the following terms, along with an example of each.
Clean claim
Rejected claim
Pending claim
Incomplete claim
Invalid claim
Dirty claim
Deleted claim
6. A short description of the necessary components of a successful claim. Include discussion of demographics,
authorizations, and clinical documentation.
Provide citations for any resources used to find information for your paper.
Save your file as a Word Document (.doc or docx).
Include the term Claims and your Last Name when saving your file. Example: Claims_Smith.docx
Upload your completed document using the Browse button, and then click the Submit button.
Points Possible: 25
20 points for content which includes everything listed above
5 points for writing guidelines

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