The CMS HCFA-1500 form is the standard paper claim form used by a non-institutional provider or supplier to bill Medicare carriers and Medicare administrative contractors (MACs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims. The form is also used to bill Medicaid State Agencies. Please contact your State Agency for more details on Medicaid billing.

	Form CMS HCFA-1500 Free PDF Template Download	DOWNLOAD CMS / NUCC Claim form 1500 (08-05) with NPI in fillable PDF template format. Read the instructions below first.
	Download Form CMS 1500 (Instruction Manual Only)	The current version of the original manual from the National Uniform Claim Comettee of how to complete the claim form 1500.

Instructions: PRINT ONLY ON OFFICIAL CMS 1500 PAPER CLAIM FORMS FOR LASER OR INK-JET PRINTERS

Paper claims submitted to Medicare are electronically read using Optical Character Recognition (OCR) equipment. This scanning technology allows for the data content on the form to be read and transferred into a format for automated processing by Medicare systems. The form fields, headings, and lines are rendered invisible to the scanner by use of what is commonly called "drop out" ink. The only acceptable claim forms are those printed in Flint OCR Red, J6983, (or exact match) ink.

THE FORM ITSELF WILL NOT PRINT ON YOUR PAPER - ONLY THE INFORMATION YOU ENTERED

The "static" form fileds are visible on the screen only. They are for easy orientation while you are entering your medical claim. They will not print over your original CMS-1500 sheet. Only the information entered by the user will print out.

Tips: 1. Make sure your Page Scaling is set to None. You can change this setting from File/Print menu. 2. Click on "Highlight Fileds" to display all fields that allow input on the screen.

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