Filing Claims

Claim Forms

Most fee for service providers use the CMS-1500 claim form to submit to third party payers.

These forms are often built into electronic payment systems or they may be purchased as a form. The National Uniform Claim Committee (NUCC) is responsible for the design and maintenance of the CMS-1500 form. 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. Each of the vendors above sells the CMS-1500 claim form in its various configurations (single part, multi-part, continuous feed, laser, etc.).

The only acceptable claim forms are those printed in Flint OCR Red, J6983, (or exact match) ink. Although a copy of the CMS-1500 form can be downloaded, copies of the form cannot be used for submission of claims, since your copy may not accurately replicate the scale and OCR color of the form. The majority of paper claims sent to carriers and DMERCs are scanned using Optical Character Recognition (OCR) technology. This scanning technology allows for the data contents contained on the form to be read while the actual form fields, headings, and lines remain invisible to the scanner. Photocopies cannot be scanned and therefore are not accepted by all carriers and DMERCs.

A fact sheet on the CMS 1500 with links to instructions and other resources please visit:

http://www.cms.gov/MLNProducts/downloads/form_cms-1500_fact_sheet.pdf
https://www.cms.gov/ElectronicBillingEDITrans/15_1450.asp ">Institutional providers may use a CMS 1450 https://www.cms.gov/ElectronicBillingEDITrans/15_1450.asp

 
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