CMS-1500 Claim Form Practice Test

The form is split into two sections by purpose: Part I is for identifying the patient and the insurer, while Part II is for the actual claim details about the services provided. In Part I you capture demographic and policy information—things like the patient’s name, date of birth, address, and the insured’s policy and group numbers. This section establishes who the patient is and who is responsible for payment or eligibility.

In Part II you record the service-level data used to process the claim: dates of service, diagnosis codes, procedure codes (CPT/HCPCS), any modifiers, charges, and provider information. This is the information the payer uses to determine coverage and payment for the professional services rendered.

So, Part I sets up identity and eligibility, while Part II details the actual medical services and billing items.