CMS 1500 Health Insurance Claim Form

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Get your CMS 1500 Health Insurance Claim Form in 3 easy steps

  • 01 Fill and edit template
  • 02 Sign it online
  • 03 Export or print immediately

What is CMS 1500 Claim?

CMS 1500 is a Claim form for Health Insurance. It was originally used to claim billing by either suppliers or a physician. The form is developed by CMS or Centers for Medicare and Medicaid. After some time, insurance carriers began to use this form. Lately, it was changed from paper to digital, with the new code on it.

What I need the Printable CMS 1500 Form for?

  • To receive the insurance for given supplies;
  • To get the money for rendered professional services;
  • To keep the information about clients, their insurance policy, treatment, and diagnosis;
  • The form is used widely by all the insurance carriers to make sure they receive the compensation they need;
  • Physicians are required to use this form to add it to the standard tax calculations once a year.

Filling out CMS 1500 Fillable Form

fillable CMS 1500 first part screenshot

This is a one-page long form. It is short and easy to fill. Check it out before you start filling it. It is divided into two parts. The top half of the form is information about the patient, and the bottom half is the information about the physician. You may need information about your:

  • Patient, including name, address, diagnosis, insurance number. You don’t actually have to repeat everything twice if it is the same as the insurance name in boxes 4 and 7. Just write Same;
  • Insurance plan. If you have two of them, you have to mark Yes in form 11D. After that, you will need to fill out the information about it.

CMS 1500 second part screenshot

Organizations that work with CMS 1500

  • Insurance companies;
  • Health Care Institutions;
  • Accredited Standard Committee.

Form Versions

2012 Fillable CMS 1500 (02-12) Fill Out Form
1990 CMS 1500 Form (12-90) Fill Out Form
Fillable online CMS 1500 Health Insurance Claim Form
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