Get Cms-1500 2006-2025

Filling out the CMS-1500 form online can be a straightforward process if you understand the components of the form and the necessary details required. This guide provides a step-by-step approach to ensuring that your claims are accurately completed for submission.

Follow the steps to successfully complete the CMS-1500 form online.

1. Press the ‘Get Form’ button to access the CMS-1500 form and open it in the editor.
2. Begin with Item 1 and indicate the type of insurance by marking the appropriate box. Only select one option.
3. In Item 1a, enter the insured's 9-digit ID number as displayed on their insurance card.
4. For Item 2, input the patient's name, ensuring you include their last name, first name, and middle initial.
5. In Item 3, provide the patient's date of birth in the format MM/DD/YY, and mark the corresponding box for their sex.
6. Item 4 requires you to input the insured's name in the same format as the patient's name.
7. Complete Item 5 with the patient's address, noting it if it differs from the insured's address listed in Item 7.
8. In Item 6, indicate the relationship of the patient to the insured by marking the correct box such as ‘Self’, ‘Spouse’, or ‘Child’.
9. Enter the insured's address in Item 7, including details like street, city, state, and ZIP code.
10. In Item 8, choose the correct option that reflects the patient's status, such as single, married, or student.
11. Item 9 requests the name of any other insured individual if applicable, with Item 9a asking for their policy or group number.
12. In Item 10, choose whether the patient's condition is related to employment, an auto accident, or another incident.
13. For Items 11 and 11a, fill in the insured's policy group number and their date of birth respectively.
14. Items 12 and 13 require signatures from the patient or authorized person and the insured or their representative.
15. In Item 14, input the date of the current illness, injury, or pregnancy using the format MM/DD/YY.
16. Items 15 and 16 allow for noting the dates of similar illnesses and any time the patient was unable to work.
17. Enter the name of the referring provider in Item 17, along with their NPI number in Item 17b.
18. For Items 18 and 21, include relevant hospitalization dates and diagnoses or nature of illness.
19. Items 22 through 24a require additional details such as prior authorization numbers, service dates, and procedure codes.
20. Finally, after reviewing all entries, you can save changes, download or print the completed CMS-1500 form, or share it as necessary.

Complete your CMS-1500 forms online today for efficient processing and management of your claims.