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CMS 1500 Insurance Claim Form versions

The CMS 1500 form has changed over the years. This form was previously called the HCFA 1500 form when Medicare and Medicaid were administered by the Health Care Financing Administration (HCFA). When the agency's name was changed to Center for Medicare and Medicaid Services (CMS) the 1500 insurance claim form was renamed the CMS 1500 Insurance Claim Forms. The names for the form are interchangeable but most people now refer to the 1500 form as the CMS 1500.

This claim form is used for filing provider claims (Part B) under the Medicare, Medicad and Tricare programs. They are generally acceptable for filing provider health insurance claims with private insurers.

Single sheet versus duplicating sets

We can provide CMS 1500 as single sheets or duplicating set.

A single sheet is a single sheet of paper CMS 1500 printed in OCR red both sides. You would order single sheet claim forms for inkjet and laser printers.

A duplicating set is 2 CMS 1500 claim forms glued together at the top. When you complete the form a copy is made of all your entries on the bottom copy. You must submit the original top copy to the insurer. The duplicate is designed to provide you with a file copy. Our duplicate sets are not continuous forms you need to tear apart. They are individual carbonless sets glued at the top of the form.

All our claim forms are printed both sides in OCR red ink to CMS standards. They are suitable for hand completion, inkjet and laser printers.

Current version 02/12

The current version of the CMS 1500 Health Insurance Claim Form is version 02/12. It is REQUIRED for any health insurance claims filed for Medicare, Medicaid, Tricare and other Federally funded health insurance program. Because it is mandated by Federal programs, the CMS 1500 Insurance has become the defacto universal health insurance claim form in the US.

It is printed in OCR red ink on both sides. It is easily identified by the QR ("scrambled egg") code in the upper left corner and in the very bootom right corner the identifier "FORM 1500 (02-12).

Prior version 08/05

The previous version for the CMS 1500 Health Insurance Claim Form was the versison 08/05. It was updated with minor changes to the 02/12 version. Some PRIVATE (not Federal) insurers still may accept this form. We have this avaiable but be sure to confirm they are acceptable to the insurers you file with.

It is printed in OCR red ink on both sides. It is identified by the number 1500 circled in the upper left corner and in the very bottom right corner the identifier "FORM 1500 (08-05).

UB04 (CMS 1450)

The UB04 is the claim form used to submit Medicare Part A claims.

We can provide these as single sheets only. Printed both sides in OCR red ink to Medicare standards.