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The Form CMS-1500 is the standard paper claim form to bill Medicare Fee-For-Service (FFS) Contractors when a paper claim is allowed. In addition to billing Medicare, the 837P and Form CMS-1500 may be suitable for billing various government and some private insurers.
To print text only on a blank, pre-existing CMS 1500 form: Navigate to the. Claims module and select Claims Manager. Select the claims to be exported. Click the Actions. drop-down and select Export/Download. Select CMS 1500 (PDF) from the drop-down and click Export.
Billing Provider Information Phone Number name, address, and phone number of provider requesting to be paid for services rendered. Billing provider address on both a CMS 1500 and UB must be the physical location; not a PO Box.
CMS does not supply the form to providers for claim submission. In order to purchase claim forms, you should contact the U.S. Government Printing Office at 1-866-512-1800, local printing companies in your area, and/or office supply stores.
Enter the patients mailing address and telephone number. On the first line enter the street address; the second line, the city and state; the third line, the ZIP code and Page 2 Instructions on how to fill out the CMS 1500 Form telephone number. If Medicare is primary, leave blank.
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In SimplePractice, you can generate CMS 1500 claim forms to submit electronically through the system, or download and print to submit outside the system.
To correctly fold your CMS form, find the designated fold lines at the sides of your form. 2. At the first fold guideline, fold your form with the sensitive information inside the fold.
How to fill out a CMS-1500 form The type of insurance and the insureds ID number. The patients full name. The patients date of birth. The insureds full name, if applicable. The patients address. The patients relationship to the insured, if applicable. The insureds address, if applicable. Field reserved for NUCC use.

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