Fill out a CMS-1500 claim form online
Medical billing may seem confusing due to healthcare providers and insurers needing to account for a number of intricate details before deciding on reimbursements. That’s why using digital CMS-1500 forms can speed up the claim settlement process. With pdfFiller, you can fill out, e-sign, and send a CMS-1500 form in minutes from any device.
This page is for informative purposes only and does not constitute tax or legal advice
What is a CMS-1500 form?
CMS-1500 is a form designed by the Centers for Medicare and Medicaid Services to standardize the filing and processing of insurance claims. Healthcare providers prepare and submit CMS-1500 forms to insurers in order to claim the incurred costs of treatment. The claim form consists of two sections:
Patient and insured information: This block specifies a patient’s personal details, including the full name, address, ID, insurance plan or program, contact info, etc.
Physician or supplier information: This is where the patient’s diagnosis is described. Also, this section specifies the healthcare services provided and the resulting fees.
Filling the form: Normally, a CMS-1500 form is fully completed by a physician or supplier. However, physicians may ask patients to fill in personal details on their own. In addition, a patient is required to sign the claim.
Signing: A CMS-1500 form must be signed by both patient and physician to be valid.
How to fill out a CMS-1500 form
Although filling out a CMS-1500 form may seem like a daunting task, the process is quite
straightforward as most fields are self-explanatory. First, the patient’s personal data
should be provided. Then, complete the form with medical-related information, specifying treatment
procedures and fees. Finally, make sure that the form has all required signatures in place.
01
Fill out all relevant fields. Make sure that items 1, 1a, 5, 11, 24B, 24D, 24E, 27, 31, 32, 33, and 33a are completed.
02
Specify a patient’s gender in item 3. Unless one of the two boxes is checked, the form will be rejected.
03
Have the patient sign and date item 12. If the patient is unable to sign due to a physical or mental condition, contact their authorized representative.
04
Refer to the ICD-9-CM system when entering diagnosis codes in item 21. Never use written descriptions in this box.
05
Specify the treatment services provided to the patient using a CPT code.
06
Enter the amounts charged for the services provided. Do not use special symbols in this field such as dollar signs, decimals, periods, etc.
07
Make sure to sign and date item 31. Only authorized healthcare providers and suppliers are eligible to sign in this box.
08
Specify the address of the healthcare facility as three separate lines: 1) name; 2) street; 3) city, state abbreviation, ZIP code.
Fill out CMS-1500 forms with pdfFiller
It’s so much easier to complete CMS-1500 forms in bulk using pdfFiller than rifling through heaps of paperwork. No need to scan, print, or ship claim forms to get them signed. What’s most important, your patients’ health data is stored and transferred in compliance with HIPAA standards.
Upload a CMS-1500 form from the pdfFiller online library and convert it to a template.
Fill out claim forms one by one or complete up to 1,000 forms at once by importing data from your CMS or database.
Send claim forms for e-signing to your patients and receive notifications once they are finished.
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