US · guidance
CMS Pub. 100-04, ch. 1, § 50.1.1
Billing Form as Request for Payment
Each of the paper billing forms--CMS-1500-- Health Insurance Claim Form; and CMS-
1490S-- Patient’s Request for Medical Payment,)-- contains a patient’s signature line or
reference to the patient signature incorporating the patient’s request for payment of
benefits, authorization to release information, and assignment of benefits. When the
billing form is used as the request for payment, there must be a signature, except when
the provisions in §50.1.2 apply.
The Medicare Uniform Institutional Provider Bill, Form CMS-1450, does not contain a
line for the patient’s signature. As a result, the billing form itself cannot be used as a
request for payment. Requests for payment must be obtained and retained in the
provider’s records. The institutional claim form contains a provider representative
signature, which includes a certification that a request for payment has been obtained
from the patient. See §50.1.2 for requirements for providers.
Electronic billing is required except when an exception is possible under ASCA. See §2
of this chapter for related information.
History
(Rev.: 4388; Issued: 09-06-19; Effective: 10-07-19; Implementation: 10-07-19)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
019a275a23874e7c885be9ea6d36f045a724845f8b6e8148720b514a130451ee
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