CMS 1500 PDF Template

Fill & Print Health Insurance Claim Form


Type, Print & Save as PDF

The CMS 1500 PDF Form Filler is ideal for completing the standard claim form used by health care providers to bill for services. Easy to download and use.  Print your first claim in just minutes!

The CMS 1500 (HCFA) is the standard paper claim form accepted by most insurance carriers. Recently revised by the National Uniform Claim Committee (NUCC) to accommodate the new ICD-10 codes.

Try the CMS 1500 PDF Demo

User Highlights


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    Easy

    Open in Adobe Reader and start typing. The form is laid out exactly like the CMS 1500, and is tabbed for quick data entry.

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    Efficient

    Save & re-use your templates over and over. Built-in help menus assist the user in accurately completing the claim.
    Optional form calculations add up the charges for you.

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    Affordable

    One-time purchase charge to create unlimited claims. Install on up to 2 computers such as home and office. Multiple user discounts available.


Professional Claims Submission

Perfect for providers submitting 1500 paper claims.
Used by acupuncturists, nurses, optometrists, physicians, podiatrists, psychologists, therapists, home health care providers, and other health care practitioners who are submitting claims for services.

Type, Print & Save your Claims


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    Type

    To get started, simply open the form with Adobe Reader on a Mac or Windows computer and start typing. The text appears as black 10 pt Arial font, required for paper claim submission. Each field has detailed callout instructions from the NUCC manual to avoid common billing errors.
    Box 1-13 – Patient/Insured Information.
    Box 14-33 – Provider/Supplier Information.

 


 
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    Print

    The CMS 1500 PDF has two print options to make it easy for providers sending professional and supplier claims on paper.

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    Print the red 1500 form with black typed text on plain paper. Print the back side which contains the instructions for various government and private health programs.

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    Put a commercially printed 1500 paper claim in the printer. Choose Text Only from the menu and print out the typed text.


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    Save

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

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

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


 

Purchase Options

CMS 1500 PDF

$29

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
  • 200 Red Paper Claim Forms
  • Free Priority Mail Shipping
Buy Now!

CMS 1500 PDF WITH FORM CALCULATIONS

$35

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
  • 200 Red Paper Claim Forms
  • Free Priority Mail Shipping
Buy Now!
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Frequently Asked Questions