Filling in the CMS 1500 Insurance Claim Form

Creating a claim in Speedy Claims is really as easy as filling in the blanks!

cms 1500 form button

Let’s start by clicking on the Claims button in the lower left of the Speedy Claims window and then clicking on the CMS 1500 Form icon.

This will open a blank CMS 1500 form on your screen. There is a small green and blue tool/info bar at the top of the form. These bars:

  • show you which form is active
  • let you choose which template to use
  • status of the claim
  • let you set the size of the form on your screen

form top

All of the fields you filled in the template will have your prefilled data in them already. You simply fill in the other fields and then click  print and you are done.

All of the data you filled in will be saved in the database for recall or reuse. The entire claim will be saved in the Claims List.

claims list

And also saved in various tables such as Patient, Provider, Insurance Company etc.

tables

This will be a real time saver for you as you can now quickly and easily reuse this data in a new claim. For instance, open a new claim form on your screen and double click inside Field 2 (Patient Name) and the Patient Table shows up. Double click on the appropriate patient and all their information is automatically filled in for you!

This shortcut can be used for ANY of the tables in  the software including:

  • Insurance Carrier
  • Patient – Field 2
  • Facility – Field 32
  • Billing Provider – Field 33
  • Referring Provider – Field 17
  • Rendering  Provider – Field 24 J
  • Diagnosis Codes – Field 21
  • Procedure Codes including Fees – Fields 24D  and 24F

Stay tuned!  Our next tutorial will include more shortcuts and time saving tips!

7 thoughts on “Filling in the CMS 1500 Insurance Claim Form”

  1. When I use control d to find patient, all the info comes up EXCEPT the insurance carrier and address. How can I get the insurance info to be included in the auto fill? Having to have the patient chart to look up the insurance carrier is making me crazy. Please help, thank you

    1. Hi Christine,

      That is a good suggestion. We have not, to this point, included the insurance carrier with patient information because of the complexity of primary carrier, secondary carrier, patients switching carriers, etc. But it is time to revisit this idea. Thanks for bringing it up.

      In the meantime, if you open a previous claim for the patient in New Copy mode from the Claims List ALL of the information from the previous claim is there including the insurance carrier name and address. Simply change the dates of service and print if the diagnosis and procedures are the same as before. Otherwise change them to and then print.

      Dan Perrine

    1. Hi Kim,

      Sure, we have one for you. You can download and print it then fill it out and send it. It is free to download and use.

      Download the front of the CMS 1500 form HERE.

      Download the back of the CMS 1500 form HERE

      Please note that many if not most of the insurance companies will not accept a form that you print yourself. The reason, as quoted from the Medicare cms.gov website is:

      “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.”

  2. I just received a denial from Molina Healthcare because your software doesn’t allow two digits in the ICD Indicator box. Most of my payors accept the claim when I write in a 1 next to the 0 to show we are using ICD-10 but apparently Molina’s scanner is not accepting written in digits. Can you adjust your software to allow the ICD Indicator field to accept “10”??
    Randi Lee

    1. Hi,

      The software does not allow two digits to be put there because there is supposed to be only 1 digit there. Either a 9 or a 0. If you click on “Help” then “NUCC Claim Form Instructions” and go to page 32 it may clarify it for you. Also under “Help” is the “Medicare Claim Form Manual”. The pages are not numbered but if you scroll down to the info on Item 21 it reads –

      • The “ICD Indicator” identifies the ICD code set being reported. Enter the applicable ICD indicator according to the following:

      Indicator Code Set
      9 ICD-9-CM diagnosis
      0 ICD-10-CM diagnosis

      Enter the indicator as a single digit between the vertical, dotted lines.

      1. I suspected that might be the case but since I don’t usually bill hardcopy, I usually bill electronically, that has not been an issue.
        The information you just provided is just the clarification and confirmation that I needed. I thank you for taking the time to respond to my inquiry.
        Randi

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