Get Cms1500 Health Insurance Claim Form - Caresource

This guide provides clear and detailed instructions on how to complete the CMS1500 health insurance claim form for CareSource online. Follow these steps to ensure accurate and efficient submission of your insurance claims.

Follow the steps to accurately complete the CMS1500 form online.

1. Press the ‘Get Form’ button to access the CMS1500 health insurance claim form online and open it in the editing interface.
2. Enter the patient’s Medicaid or CareSource ID number in Field 1.
3. In Field 1a, input the patient's last name, first name, and middle initial.
4. Fill in Field 2 with the patient’s date of birth.
5. Repeat the patient's name in Field 3.
6. In Field 4, add the patient’s street address, city, state, ZIP code, and telephone number.
7. For the patient's marital status in Field 5, mark the appropriate box.
8. Fill in the patient's address again in Field 6.
9. Leave Fields 7 and 8 blank.
10. In Field 9, provide the patient’s home phone number as well.
11. In Fields 10, 11, and 11a, include any relevant information regarding the claim and the patient's condition.
12. Input the total amount charged for services in Field 24, including details about the services provided in the subsequent subfields.
13. Complete Fields 25 through 33 with the necessary provider and billing information, signing where required.
14. Once completed, save your changes, download your form, print it for records, or share it as necessary.

Complete your CMS1500 health insurance claim form online for a streamlined submission process.