CMS 1500 Claim Form PDF

CMS 1500 Claim Form PDF Download

Free download PDF of CMS 1500 Claim Form using the direct link provided at the bottom of the PDF description.


CMS 1500 Claim Form - Description

Dear readers, here we are offering CMS 1500 Claim Form PDF to all of you. The CMS-1500 form is a standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider is in compliance with Administrative Simplification Compliance Act (ASCA) requirements. If an emergency arises, you may need to rush to a nearby hospital for treatment. Even, when you have a planned surgery, you may be able to avail treatment at a hospital near you or where you live. If your treating doctor works at a specific hospital, you may prefer it over others. Qualifies for exemption from Electronic submission of claims. It is also used for billing some Medicaid state agencies. Please contact your Medicaid state agency for more information. The hospital may not be on your insurer’s list of network hospitals. The National Uniform Claims Committee (NUCC) is responsible for the design and maintenance of the CMS-1500 form. CMS does not supply forms to providers for claim submission. To purchase claim forms, you should contact the US Government Printing Office at 1-866-512-1800, local printing companies in your area, and/or office supply stores. Each of the above vendors sells the CMS-1500 claim form in its various configurations (single part, multi-part, continuous feed, laser, etc.).

CMS 1500 Claim Form Instructions PDF

  • Enter the data within the boundaries of the fields provided and ensure all information is aligned properly. Do not write between lines.
  • Type (in Arial or Times New Roman font) or print all information. Entries should be dark enough to be legible.
  • Use black ink only. Red and blue ink cannot be properly “read” by the scanning equipment.
  • Do not highlight the claim form or attachments. Highlighted information can become “blackedout” when scanned.
  • Do not submit claim forms with corrections, such as information written over correction fluid or crossed out information. If mistakes are made, complete a new form.
  • Capitalize alpha characters. Do not use special characters (e.g., dollar signs, decimals, dashes). Do not use commas to separate thousands.
  • Do not write or use staples on the bar-code area.
  • Do not use adhesive labels (e.g., address) or place stickers on the form. Do not use a rubber stamp in any fields on the form.

You can download CMS 1500 Claim Form PDF by clicking on the following download button.

Download CMS 1500 Claim Form PDF using below link

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