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Fiachra Forms LLC provides charting solutions for health care professionals. Our goal is to help our clients realize a faster way of documenting clinical care without needing expensive software. 
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Submitting a HCFA CMS 1500 Paper Claim

Oct 10th 2015 at 4:56 AM

When the patient contacts a healthcare provider’s office for services, an insurance claim is used to report the professional and technical services provided.  This form is the universal claim form, known as the CMS-1500 claim.

Most offices submit electronic claims, but there are still small offices that submit paper claims. Providers sending professional and supplier claims on paper must use Form CMS-1500.  You will know if you have the correct edition of the 1500 form if at the top of the form, it states, “Approved by National Uniform Claim Committee (NUCC) 02/12, and in the bottom right corner, “Approved OMB-0938-1197 Form 1500 (02-12).

When submitting the claim, fill in the patient information by completing items (1) through (13) using the 1500 Fillable PDF Template. The physician or supplier must then complete items (14) through (33).

Print with Red form and black type on plain paper.  Print the backside  patient disclaimer page as well. You can also put a Commercially Printed 1500 Paper Claim in the printer and choose Print Text Only from the menu. The form is aligned to place the text in the proper spaces.

Medicare A/B MACS (B), DME MACS, physicians, and suppliers are responsible for purchasing their own CMS-1500 claim forms. Paper claims can be obtained here as they follow the specifications developed by the NUCC. Photocopies of the CMS-1500 claim form are NOT acceptable. Medicare will accept any type (i.e., single sheet, snap-out, continuous feed, etc.) of the CMS-1500 claim form for processing.


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