§ 424.32 Basic requirements for all claims.
(a) A claim must meet the following requirements:
(1) A claim must be filed with the appropriate intermediary or carrier on a form prescribed by CMS in accordance with CMS instructions.
(2) A claim for physician services, clinical psychologist services, or clinical social worker services must include appropriate diagnostic coding for those services using ICD-9-CM.
(3) A claim must be signed by the beneficiary or on behalf of the beneficiary (in accordance with § 424.36).
(4) A claim must be filed within the time limits specified in § 424.44.
(5) All Part B claims for services furnished to SNF residents (whether filed by the SNF or by another entity) must include the SNF's Medicare provider number and appropriate HCPCS coding.
(b) The prescribed forms for claims are the following:
CMS-1450—Uniform Institutional Provider Bill. (This form is for institutional provider billing for Medicare inpatient, outpatient and home health services.)
CMS-1490S—Request for Medicare payment. (For use by a patient to request payment for medical expenses.)
CMS-1500—Health Insurance Claim Form. (For use by physicians and other suppliers to request payment for medical services.)
CMS-1660—Request for Information-Medicare Payment for Services to a Patient now Deceased. (For use in requesting amounts payable under title XVIII to a deceased beneficiary.)