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Medicare Claims Processing Manual, Chapter 26
Items 14 - 33 Providers sending professional and supplier claims to Medicare on paper must use Form. CMS-1500 in a valid version. This form is maintained by
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Revised 1500 Claim Form Instructions
by JB Doe The National Uniform Claim Committee (NUCC) released a revised 1500 Claim Form, which is commonly referred to as the CMS-1500. The revised CMS-1500 (02/12)
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quest-health-insurance-1500-claim-form.pdf
READ BACK OF FORM BEFORE COMPLETING SIGNING THIS FORM. 12. PATIENTS OR AUTHORIZED PERSONS SIGNATURE I authorize the release of any medical or other
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