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The Health Insurance Claim Form (CMS-1500) is used by Allied Health professionals, physicians, laboratories and pharmacies to bill supplies and services to the Medi-Cal program.
The Form CMS-L564 is used for proof of group health plan coverage based on current employment (i.e., active coverage), which is needed to process the Medicare enrollment application.
WHAT TO DO IF YOURE A NEW PHYSICIAN, PRACTITIONER OR SUPPLIER: If you choose to be a participant: Complete the blank agreement (CMS-460) and submit it with your Medicare enrollment application to your MAC.
The Form CMS-29 is utilized as an application to be completed by suppliers of RHC services requesting participation in the Medicare/Medicaid programs. This form initiates the process of obtaining a decision as to whether the conditions for certification are met as a supplier of RHC services.
If you receive a settlement, judgment, award, or other payment related to this claim and Medicare determines that it has made conditional payments that must be repaid, you will get a demand letter.
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The 1500 form, also known as the CMS-1500 form, is a standard form used by healthcare providers and medical billing companies in the United States to submit claims for processing with insurance companies (see Graphic 1). Graphic 1: Sample 1500 form.
The Health Insurance Claim Form (CMS-1500) is used by Allied Health professionals, physicians, laboratories and pharmacies to bill supplies and services to the Medi-Cal program. Providers are required to purchase CMS-1500 claim forms from a vendor. Claim forms ordered through vendors must include red drop-out ink.

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