Previewing CMS 1500 Forms

  1. Search for a claim whose CMS 1500 formClosed Formerly HCFA. The standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims. It is also used for billing to some Medicaid state agencies. you want to preview.

    For more information, go to Searching for Claims.

  2. Perform one of the following tasks in the Process Claims: Claim Search screen:
    • In the row of the claim whose CMS 1500 form you want to preview, select Preview New CMS Form (Version 02/12) from the Action drop-down list.
    • In the Claim # column, click the link of the claim for the claim whose CMS 1500 form you want to preview. Then, click Preview CMS Form.

    The CMS 1500 form opens as a PDF in a new window.