Get the up-to-date cms 1500 claim form 2016-2024 now

Get Form
cms 1500 claim form 2016 Preview on Page 1

Here's how it works

01. Edit your form online
01. Edit your form online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
03. Share your form with others
Send it via email, link, or fax. You can also download it, export it or print it out.

The easiest way to edit Cms 1500 claim form 2016 in PDF format online

Form edit decoration
9.5
Ease of Setup
DocHub User Ratings on G2
9.0
Ease of Use
DocHub User Ratings on G2

Handling paperwork with our feature-rich and intuitive PDF editor is easy. Adhere to the instructions below to fill out Cms 1500 claim form 2016 online quickly and easily:

  1. Log in to your account. Log in with your credentials or register a free account to test the product before choosing the subscription.
  2. Upload a document. Drag and drop the file from your device or import it from other services, like Google Drive, OneDrive, Dropbox, or an external link.
  3. Edit Cms 1500 claim form 2016. Quickly add and underline text, insert images, checkmarks, and signs, drop new fillable areas, and rearrange or delete pages from your paperwork.
  4. Get the Cms 1500 claim form 2016 accomplished. Download your modified document, export it to the cloud, print it from the editor, or share it with other people through a Shareable link or as an email attachment.

Take advantage of DocHub, one of the most easy-to-use editors to rapidly manage your paperwork online!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us
When a physician has a private practice but performs services at an institutional facility such as a hospital or outpatient facility, the CMS-1500 form would be used to bill for their services. The UB-04 (CMS-1450) form is the claim form for institutional facilities such as hospitals or outpatient facilities.
These boxes are divided into two main sections: Patient and Insured Information. Physician or Supplier Information.
LATEST APPROVED VERSION FORMS: CMS/HCFA 1500 claim forms (02/2012 version) are the currently approved forms that replaced (version 08/05) CMS-1500 Forms; required for health care providers to bill a patient's insurance company for reimbursement of medical claims.
Box 23 is used to show the payer assigned number authorizing the service(s).
LATEST APPROVED VERSION FORMS: CMS/HCFA 1500 claim forms (02/2012 version) are the currently approved forms that replaced (version 08/05) CMS-1500 Forms; required for health care providers to bill a patient's insurance company for reimbursement of medical claims.
be ready to get more

Complete this form in 5 minutes or less

Get form

People also ask

Item 17a \u2013 Enter the ID qualifier 1G, followed by the CMS assigned UPIN of the referring/ordering physician listed in item 17. The UPIN may be reported on the Form CMS-1500 until May 22, 2007, and MUST be reported if an NPI is not available.
LATEST APPROVED VERSION FORMS: CMS/HCFA 1500 claim forms (02/2012 version) are the currently approved forms that replaced (version 08/05) CMS-1500 Forms; required for health care providers to bill a patient's insurance company for reimbursement of medical claims.
The CMS-1500 claim form is used to submit non-institutional claims for health care services provided by physicians, other providers and suppliers to Medicare. It is also used for submitting claims to many private payers and Medicaid programs, as well as other government health insurance programs.
The NUCC has recently changed the Form CMS-1500, and the revised form received OMB approval on June 10, 2013. The revised form is version 02/12, OMB control number 0938-1197.
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).

Related links