CMS 1500 Fillable Claim Form

The Universal Claim Form

The CMS 1500 is the standard health insurance claim form accepted by most insurance carriers. It has been updated by the National Uniform Claim Committee (NUCC) to accommodate the current ICD-10 billing codes.

Our PDF Template of the CMS 1500 can be used by all health care providers to bill for services. Easy to download and use. Type in the form fields and print your first claim in just minutes!

 
DOWNLOAD THE DEMO
 

User Highlights

  • Easy to Use:  Open in Adobe Reader and start typing. The form looks exactly like the CMS 1500 on the computer screen.

  • Efficient: Save & re-use your templates over and over. Optional form calculations add up the service charges for you.

  • Affordable: One-time purchase charge to create unlimited claims. Install on up to 2 computers such as home and office.

Purchase Options

CMS 1500 PDF Single User

$39

One Time Purchase


  • Type, Print & Save as PDF

  • Create Unlimited Claims

  • Prints 1500 and Typed Text

  • Prints Text Only

  • Install on 2 Computers

Buy & Download

CMS 1500 PDF With Form Calculations

$45

One Time Purchase



    • Type, Print & Save as PDF

    • Create Unlimited Claims
    • Prints 1500 and Typed Text

    • Prints Text Only

    • Install on 2 Computers

    • Adds Up Charges Automatically
    Buy & Download 

    Billing Package CMS 1500 PDF & Paper Claims

    $ 59

    One Time Purchase

    • CMS 1500 PDF w/Calculations
    • 200 Red Paper Claim Forms
    • 2019 CMS 1500 USER GUIDE
    • Free Priority Mail Shipping
    Buy & Download 


    Download CMS 1500 PDF + Guide 
    Paper claims mailed out same day

    Using the Fillable 1500 Claim Form

    • Getting Started

      To get started, open the form with Adobe Reader on your Mac or Windows computer and type in the fields. The PDF has the “look and feel” of the original CMS-1500. The fill fields are positioned to match nucc.org placement grid on the standard claim. 

    • Easy Data Entry

      The familiar layout is highlighted in blue and tabbed for fast data entry. Each field includes detailed instructions to help the user avoid common billing errors. Adds up service charges automatically (optional feature).

    • Mac & Windows

      This PDF is designed to work with Adobe Reader software, the free and trusted PDF viewer. Type, each claim on your computer, not online or in the cloud.

    Type in the Claim

    Fields 1-13 are for patient information
    Fields 14-24 - Procedural and diagnostic information
    Fields 25-33 - Servicing and the billing provider information.

    CMS 1500 User Guide Available

    Billing Package - CMS 1500 PDF & 200 Claim Forms

    Print your Claim

    It may not be possible to replicate the red form color with your printer. We recommend using the commercially printed claim forms to ensure your claim is accepted and processed.

    • Print Options

      The CMS 1500 PDF has two print options built into the menu at the top left of the PDF.

    • Print the red 1500 form with black typed text on plain paper. Print the back side as well to ensure the claim will be accepted.

    • If you have a commercially printed 1500 paper claim, choose to print "text only" from the menu.

    Need Paper Claims for your Printer?

    Billing Package - CMS 1500 PDF & 200 Claim Forms

    • Saving the Claim

      Save each claim with a unique file name on your computer. Create your own office or patient templates to save time and avoid payment errors.

    • Save on up to two computers, such as home and office. Easily open, edit and resave the template over and over.

    • Keep Protected Health Information (PHI) safe by following your computer safeguards to meet HIPAA Security Rules.

    Security

    The CMS 1500 PDF is saved safely to your Mac or PC
    keeping confidential patient information offline.