CMS-1500 Form for BlueCard - Dgaplans.org - dgaplans-2025

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Medicare will accept any Page 3 type (i.e., single sheet, snap-out, continuous feed, etc.) of the CMS-1500 claim form for processing. To purchase forms from the U.S. Government Printing Office, call (202) 512-1800. The following instructions are required for a Medicare claim.
Open the local file with your systems PDF reader. Navigate to Save and Print Options and select Print Text Only.
Printing your CMS 1500 form After saving your claim form, you can submit it electronically through SimplePractice, or download it to print. Important: If you are downloading a secondary claim form, you will notice that the downloaded PDF does not match that of the claim form you see in SimplePractice.
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. Each of the vendors above sells the CMS-1500 claim form in its various configurations (single part, multi-part, continuous feed, laser, etc).
Can CMS 1500 Forms be Handwritten? While it is technically possible to handwrite a CMS 1500 form, it is generally not recommended.
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To print a 1500 form and update the margins. From Billing Manager, Select the Option Print and then select Claims In the Print Claims Box, Click the Print Settings button. Click Print Test form and Select the Printer needed. For the first print, leave the top margin, left margin, font size, and font as defaulted.
Box 23 - TITLE: Prior Authorization Number (this field is also used for CLIA numbers) INSTRUCTIONS: Enter any of the following: prior authorization number, referral number, or Clinical Laboratory Improvement Amendments (CLIA) number, as assigned by the payer for the current service.