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Cms 1500 Form: What You Should Know

C-3, EC-3); and Final Notice of Payroll Adjustment (Forms C-3, EC-3).  In the same order, the Board expanded the use of the CMS-1500 by waiving the two forms required in the previous rules: Annual Summary of Employer's (Form 890.20) and Employee's (Form 890.20) Employer's Contributions (Forms 890.22 and 890.23). The Board has also adopted the following revisions:  (1) All references in other Forms of Records to Forms C-4, EC-4, or Form RRB-1500 have been eliminated; (2) The information set forth in Forms RRB-1500 or C-7 shall be used in the absence of any specific directions or information on the subject from the insurance entity to include an explanation of whom the insurance entity is and the terms of their policies regarding reimbursement.  CMS-1500 Initiative Overview — Workers' Compensation Board (1) The Insurance Bureau has eliminated Form C-7 as required by O.I.C. 12-90; (2) The Insurance Bureau has corrected the incorrect data appearing in Forms EC-4 and RRB-1500; and, (3) Form EC-7 shall also be used for the purposes of processing claim payments, rather than as an affidavit used to verify an authorization of claim payments.  (4) The Insurance Bureau has also eliminated the mandatory instructions in Forms EC-4, EC-7, and RRB-1500 that required a signature of a doctor in Form C-4, EC-4.  In the same order, the Board added two new forms to the CMS-1500: Claim for Relief and Claims for Additional Benefits. (Form C-1) and Affidavit to Recover Pregnancy Sick Pay Due to Miscarriage (Form C-2). CMS-1500 Initiative Overview — Insurance Bureau and Workers' Compensation Bureau In the same order, the Board added the following forms to the CMS-1500: Worker's Medical Information Form (Form RRB-1500); and, Annual and Final Payment Forms for Employer and Employee's Payments (Forms RRB-1500 and ES-1500). All of these forms will be used to process claims.  In the same order, the Board has also added the following Forms:  (1) O.I.C.

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