CMS 1500 PDF Template


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.

The CMS 1500 PDF is 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! Unlimited use!

DOWNLOAD THE CMS 1500 PDF

User Highlights


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    Easy

    Open in Adobe Reader and start typing. The form looks exactly like the CMS 1500 on the computer screen.

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    Efficient

    Save & re-use your templates over and over. Optional form calculations add up the service 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.


Professional Claims Submission

Used by acupuncturists, nurses, optometrists, physicians, psychologists, therapists, home health care providers, and other health care practitioners submitting claims for services.

Using the Fillable 1500 Claim Form


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    Type

    To get started, open the form with Adobe Reader on your Mac or Windows computer and type in the fields. The fill fields are positioned to match nucc.org placement grid on the standard claim. 

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    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.

Type in the Claim

Fields 1-13 – Patient & Insured Information.
Fields 14-33 – Procedural & Provider Information.



Print out the Claim

Use blank paper or a red claim form in the printer.

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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 as well to ensure the claim will be accepted.

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


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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.


Save the Claim

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

 
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Purchase Options

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Frequently Asked Questions