Screenshot of CMS-1500 PDF (02/12) Designed for health care providers using the standard paper claim to bill for services.

The newly revised form allows for ICD-10 reporting, and brings uniformity with the current health care claims requirements.

Type, Save & Print your claims using Adobe Reader software.

CMS-1500 PDF DemoDownload the Demo Here

Still need the 08/05 version of the CMS-1500? Buy Both!

User Highlights

Easy - Just like the CMS-1500. Simply type in the form fields using Adobe Reader.
Smart - Helpful built-in messages assist the user. Prints text only on paper claims.
Efficient - Create unlimited claims. Save & re-use your templates over and over.
Affordable - One-time purchase. Install on up to 2 computers such as home and office.
Compatible - Works with both Mac & Windows when using Adobe Reader.

Optional Form Calculations: Automatically adds up the charges (1-6 in Box 24F) for total charge in Box 28. To manually edit the calculation, turn it off at the bottom of the form.

System Requirements

This fillable PDF requires Adobe Reader, version 9 or greater to type, save and print form fields.
Download the latest version of Adobe Reader, the free, trusted standard for PDF files.
Important: Mac and Windows 8 both have a default PDF viewer. Be sure to open Adobe Reader first, then the CMS-1500 PDF from within Adobe Reader to print and save the claim properly.

Fiachra Forms offers individual support at any time, through video tutorials, a community forum, and detailed email responses for any issues that you may encounter.

Print and Save Options

Video TutorialSee a step by step video tutorial here

The CMS 1500 PDF allows the user to fill, save, and edit the claim form fields. Once completed, use the built-in menu to save, print and clear the form. To create a template, a claim to use over and over, fill in the form, then choose Save and name your template. Now open the template, edit and save with the new claim name.

Printing Form and Text

Open the CMS 1500 PDF and fill in the patient information. In the menu choose Print All. This option will print the red form with typed text and the backside. Be sure to set for two-sided printing.
Note: It may not be possible to replicate the form color (OCR Red, Flint J-6983) with your printer. We recommend sending a sample first, or print "Text Only" to ensure your claim is accepted.

Printing Text Only
Put a Commercially Printed 1500 (02/12) Paper Claim in the printer and choose Print Text Only from the menu. The form is already aligned, and will place the text in the proper spaces.

User License
Purchase of the CMS-1500 PDF entitles the user to perpetual use of the form, for an unlimited amount of time. A licensed user may open, use, access, display and copy the CMS-1500 PDF on up to two (2) computers. This license and PDF file may not be shared, transferred or used by others. If your agency has additional user licenses, the purchaser must be willing to manage the deployment and utilization of each license of the CMS-1500 PDF within the agency.