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Number (for program in item 1) 4. Claims may be electronically submitted to a medicare carrier, durable medical equipment medicare administrative contractor (dmemac), or a/b mac from a provider's office using a computer with software that meets electronic filing requirements as established by the hipaa claim. Read the instructions and tips below first. The current version of the original manual from the national uniform claim comettee of how to complete the cms1500 claim form. Insured’s policy group or feca number a. Because this form is used by various government and private health programs, see separate instructions issued by applicable programs. Authority to collect information is in section 205(a), 1862, 1872 and 1874 of the social security act as amended, 42 cfr 411.24(a) and 424.5(a) (6), and Web cms 1500 dynamic list information. Billing various government and some private insurers. This cms 1500 form, fillable and simple to use, is available to anyone who needs it.
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