Get Sample Cms-1500 (2-12) Form

Filling out the Sample CMS-1500 (2-12) Form online is a crucial process for healthcare providers to ensure proper billing and payment for services rendered. This guide will provide you with a step-by-step approach to accurately complete each section of the form.

Follow the steps to fill out the Sample CMS-1500 (2-12) Form online.

1. Press the 'Get Form' button to access the Sample CMS-1500 (2-12) Form and open it in your preferred editor.
2. In Block 1, provide the patient's personal information, including their name and address. Be sure to include the correct Medicare or insurance ID number in Block 1a.
3. Go to Blocks 2-5 to input the patient's date of birth, gender, and information about the insured party if it differs from the patient.
4. In Block 6, indicate the relationship of the insured to the patient. Use the appropriate box for spouse, child, or other relationships.
5. Complete Block 7 with the insured's address and the insurance policy number in Block 8. Be careful to ensure all information matches the official insurance records.
6. Fill out Blocks 9-12, providing details about the condition being treated and the service date. This section may require specific diagnosis codes, so verify this information before submitting.
7. Review Blocks 13-29 for additional information on the procedures performed, including the dates, the place of service, and the amount charged for each procedure.
8. Finally, complete Block 31 with the provider's signature and credentials. Make sure to verify all entries for accuracy.
9. Once you have filled out all the necessary sections of the form, save your changes. You may choose to download or print the form for your records or to submit it to the appropriate payer.

Start filing your documents online now to ensure timely processing and payment.