Pdf cms 1500 download

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All Rights Reserved. Although it was developed by The Centers for Medicare and Medicaid CMS , it has become the standard form used by all insurance carriers. It provides information about the client, their corresponding insurance policy, and their diagnosis and treatment. Additionally, most insurances allow you to send an electronic version, called an file. Make sure you have the correct version before submission. The CMS form, like most government-mandated forms, has many different fields all requiring unique information.

They have each field individually numbered and a corresponding key below for ease of understanding. There are some software options for filling out your CMS form, though quality free CMS form-filler software is hard to come by. For a sample CMS form filled out , check out this example. Please note: This is for visual sample purposes only and should not be used as a guide.

Here are the steps for an easy fold. Your form should fit perfectly in its envelope with the address visible through the window. Date Added March 15, Version Operating Systems. Additional Requirements Adobe Reader Total Downloads 3, Downloads Last Week 3. Report Software. Related Software. Ezy Invoice Free. Create and manage your Invoices, Quotes. Additionally, you must provide his or her telephone number as well, being sure to include the area code.

If the patient is different from the insured, then the insured must write down the same details. If the insured is different from the patient, then the insured must write down these same details.

You will also need similar details for the insured. You can indicate any of the following boxes: employment , auto-accident , or other accident. If the auto-accident box is ticked, you will be asked to indicate the state where the accident took place.

If there is another benefit plan, you will be asked to indicate so. You will need the date of the current illness , injury , or pregnancy. If the patient has had similar illness in the past, please write the first date of said illness. You will also be asked to write the period of time where the patient was unable to work at their current job by indicating the from and to dates as well as the period of time where the patient was hospitalized.

You will next have to write the name of the referring provider or other source , as well as the NPI. You must then indicate if there was an outside lab involved, as well as write down any monetary charges. Tips for Filling the Template It is very important to ensure the information is accuracy and exactness when you are filling the health insurance claim form The following tips will help you fill out CMS successfully and accurately: Always use Pica or Arial fonts to fill out these forms.

The font size is between 10 and Fill the form with capital letters and always use black ink or black fonts. Do not use italics or broken characters, dot matrix fonts, stylized fonts, or red ink when filling out the CMS form.