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The background image is being printed? This should help.ģ. You can change this setting from File/Print menu.Ģ. Make sure your Page Scaling is set to None. Only the information entered by the user will print out. They will not print over your original CMS-1500 sheet. They are for easy orientation while you are entering your medical claim. The 'static' form fileds are visible on the screen only. THE FORM ITSELF WILL NOT PRINT ON YOUR PAPER - ONLY THE INFORMATION YOU ENTERED The only acceptable claim forms are those printed in Flint OCR Red, J6983, (or exact match) ink. The form fields, headings, and lines are rendered invisible to the scanner by use of what is commonly called 'drop out' ink. This scanning technology allows for the data content on the form to be read and transferred into a format for automated processing by Medicare systems. Paper claims submitted to Medicare are electronically read using Optical Character Recognition (OCR) equipment.

PRINT ONLY ON OFFICIAL CMS 1500 PAPER CLAIM FORMS FOR LASER OR INK-JET PRINTERS.

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The current version of the original manual from the National Uniform Claim Comettee of how to complete the CMS1500 claim form. Read the instructions and tips below first. Please contact your State Agency for more details on Medicaid billing.įREE CMS-1500 (HCFA) CLAIM FORM TEMPLATE PDFĭOWNLOAD FREE CMS 1500 CLAIM FORM FILLABLE TEMPLATE. The form is also used to bill Medicaid State Agencies. The CMS-1500 form is the standard paper claim form used by a non-institutional provider or supplier to bill Medicare carriers and Medicare administrative contractors (MACs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims. Home > Billing Software > fillable CMS 1500 claim form FREE FILLABLE CMS medical claim FORM 1500 template with instructions Manual