The CMS-1500 form is 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 of some Medicaid State Agencies. Please contact your Medicaid State Agency for more details.

The only acceptable claim forms are those printed in Flint Red, J6983, (or exact match) ink. Do not submit photocopied claims. The majority of paper claims sent to carriers and DMERCs are scanned using Optical character recognition (OCR) technology. This scanning technology allows for the data contents contained on the form to be read while the actual form fields, headings, and lines remain invisible to the scanner. Photocopies cannot be scanned and therefore are not accepted by all carriers and DMERCs.

You can find basic form completion instructions and print specifications for the CMS-1500 in Chapter 26 of the Medicare Claims Processing Manual (Pub.100-04).

The New CMS 1500 Form (8-05) does not use a bar code.

THIS PRODUCT MAY BE RETURNED IF YOU ORDER INCORRECTLY.  THERE IS A 20% RESTOCKING FEE, FREIGHT IS NON-REFUNDABLE.

For CMS/HCFA 1500 Insurance Claim Envelopes

Item #: CMS-1500-LC-500-PK Laser 8-1/2" x 11" cut sheet 20# bond red ink. 500 pack. ACS Low Prices   Price is per pack, 500 per pack 1 : $15.00

Item #: CMSLC-1500 Laser 8-1/2" x 11" cut sheet 20# bond red ink. ACS Low Prices   Price is per case, 2500 per case 1 - 2 : $43.00 3 - 5 : $41.00 6 or more : $38.00

Item #: CMSS-1500 Snap apart Carbonless 2 parts, detached size 8-1/2" x 11" perf at top 20# top copy bond red ink with bar code. ACS Low Prices   Price is per case, 1000 per case 1 - 2 : $64.00 3 - 5 : $62.00 6 or more : $60.00

Item #: CMS1-1500 Continuous 1 part 9-1/2" x 11" perfs l & r 20# bond red ink ACS Low Prices   Price is per case, 2500 per case 1 - 2 : $42.00 3 - 5 : $40.00 6 or more : $38.00

Item #: CMS2-1500 Carbonless Continuous 2 part 9-1/2" x 11" perfs l & r 20# top copy bond red ink ACS Low Prices   Price is per case, 1000 per case 1 - 2 : $42.00 3 - 5 : $40.00 6 or more : $38.00

Item #: CMS3-1500 Carbonless Continuous 3 part 9-1/2" x 11" perfs l & r 20# top copy bond red ink ACS Low Prices   Price is per case, 1000 per case 1 - 2 : $78.00 3 - 5 : $76.00 6 or more : $74.00