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!

Mac/Windows compatible when using Adobe Reader.


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Try the CMS 1500 PDF Demo

The CMS 1500 (HCFA) is the standard paper claim form accepted by most commercial and private insurance carriers. The new CMS 1500 (02/12) has been revised by the National Uniform Claim Committee (NUCC) to accommodate recent changes. The form now accepts ICD-10 codes, expanding the number of possible diagnosis codes on a claim to 12. The form also uses letters, instead of numbers, as the diagnosis code pointers.

User Highlights


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    Easy

    Type in the form fields using Adobe Reader. Has the “look and feel” of the original CMS-1500 designed by the NUCC. Fill fields are highlighted in blue and are 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 acupuncturist, nurses, optometrists, physicians, podiatrists, psychologists, therapists, home health care providers, and other health care practitioners who are submitting claims for services.

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other Happy Billing Customers!

Easy Claims Submission

Claims now typed, printed & saved to your computer

Type in the Claim

Screenshots


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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.

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    The familiar layout is highlighted in blue and tabbed for fast data entry. 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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    Paper claims are now encouraged to be typed, which are scanned using Optical Character Recognition (OCR) to avoid payment errors. The red form color is invisible to the scanner.


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    Print

    The CMS 1500 PDF Template has two print options to make it easy for providers sending professional and supplier claims on paper. Print on blank paper, or print just the typed text on a commercially printed claim form that you already have.

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    Print the red 1500 form with black typed text on plain paper. You can print the back side as well, 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 and choose Print Text Only from the menu. The form is aligned to place the text in the proper spaces.

Print Red Form & Text

Screenshots


Save to Computer

Screenshots


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    Save

    Once you have completed the claim, save each claim with a unique file name. You can create unlimited claims using the CMS-1500 PDF. Create your own office or patient templates to save time and avoid payment errors.

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    Save on up to 2 computers, such as home and office. Easily open, edit and resave the template over and over. Correct claims quickly if they are rejected for missing, incomplete or invalid information.

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    Keep Protected Health Information (PHI) safe by following your computer safeguards to meet HIPAA Security Rules.
    The CMS 1500 PDF is never filled or saved online keeping information confidential.

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!

BILLING PACKAGE

$ 55

CMS 1500 PDF & Paper Claim Forms
  • 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!

Immediate Download  after Purchase with Credit Card or PayPal.
For any questions regarding our pricing plans above, don’t hesitate to contact us!

Frequently Asked Questions