Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.65 - Standardized claim format

Current through June 24, 2024
(1) PURPOSE;
			 APPLICABILITY. This section implements s.
			 632.725(2)
			 (a) and (b), Stats., by designating and
			 establishing requirements for use of the forms that health care providers in
			 this state shall use on and after July 1, 1993, for providing a health
			 insurance claim form directly to a patient or filing a claim with an insurer on
			 behalf of a patient.
(2)
			 DEFINITIONS. In this section and in s.
			 Ins
			 3.651:
(a) "ADA
			 dental claim form" means the uniform dental claim form approved by the American
			 dental association for use by dentists.
(b) "CDT-1 codes" means the current dental
			 terminology published by the American dental association.
(c) "CPT-4 codes" means the current
			 procedural terminology published by the American medical association.
(d) "DSM-III-R codes" means the American
			 psychiatric association's codes for mental disorders.
(e) "HCFA" means the federal health care
			 financing administration of the U.S. department of health and human
			 services.
(f) "HCFA-1450 form"
			 means the health insurance claim form published by HCFA for use by
			 institutional providers.
(g)
			 "HCFA-1500 form" means the health insurance claim form published by HCFA for
			 use by health care professionals.
(h) "HCPCS codes" means HCFA's common
			 procedure coding system which includes all of the following:
1. Level 1 codes which are the CPT-4
			 codes.
2. Level 2 codes which are
			 codes for procedures for which there are no CPT-4 codes.
3. Levels 1 and 2 modifiers.
(i) "Health care provider" has the
			 meaning given in s.
			 632.725(1),
			 Stats.
(j) "ICD-9-CM codes" means
			 the disease codes in the international classification of diseases, 9th
			 revision, clinical modification published by the U.S. department of health and
			 human services.
(k) "Medicare"
			 means Title XVIII of the federal social security act.
(L) "Medical assistance" means Title XIX of
			 the federal social security act.
(m) "Revenue codes" means the codes which are
			 included in the Wisconsin uniform billing manual and which are established for
			 use by institutional health care providers by the national uniform billing
			 committee.
Note:
The publications and forms referred to in
				subsection (2) may be obtained as follows: HCFA-1500 form and
				instructions
From the U.S. Government Printing Office, 710 North Capitol
				Street NW, Washington, DC 20401, all of the following:
HCPCS codes
ICD-9-CM codes
HCFA-1450 form and instructions
From the American Dental Association, 211 East Chicago Avenue,
				Chicago, IL 60611, both of the following:
CDT-1 codes
ADA dental claim form and CDT-1 User's Manual
From Order Department: OP054192, the American Medical
				Association, P. O. Box 10950, Chicago, IL 60610: CPT-4 codes
From the American Psychiatric Association, 1400 K Street, NW,
				Washington, DC 20005: DSM-III-R codes
From the Wisconsin Hospital Association, 5721 Odana Road,
				Madison, WI 53719: Wisconsin Uniform Billing Manual and revenue codes