Reprinting CMS 1500 Forms

You can reprint a CMS 1500 form 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. only after the claim has been billed. (Printing a CMS 1500 form marks that claim as Billed.) Reprinting the CMS 1500 form does not change the status of the claim.

1. Search for a billed claim whose CMS 1500 form you want to reprint.

   For more information on searching for claims, go to Searching for Claims.

2. In the row of the claim whose CMS 1500 form you want to reprint, select Reprint New CMS Form (Version 02/12) from the Action drop-down list.

   The CMS 1500 form opens in a new window.

3. Click Print.