Which document is usually used to submit claims for outpatient services?

The CMS-1500 is the standard claim form used for billing outpatient medical services and is specifically designed for healthcare providers who are submitting claims to insurance companies. It is utilized primarily by individual practitioners and small group practices, allowing them to detail the patient’s diagnosis, procedures performed, and billing information effectively.

This form is crucial in the outpatient setting because it captures necessary information, such as the patient’s personal details, the services rendered, and the corresponding codes for diagnoses and procedures, in a format that insurance companies can process. The use of this form ensures that claims are filed properly, maximizing both efficiency and the likelihood of reimbursement.

In contrast, the UB-04 form is used primarily for inpatient hospital services and facility billing, while the superbill is a detailed receipt provided to patients outlining the services received, which may not be directly submitted to insurance companies. The encounter form, although it serves a similar purpose by summarizing the visit for the patient, is not an official claim submission document. Thus, the CMS-1500 is the correct form for outpatient claims.