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Back to CMS Forms List CMS 1500 Form Title Health Insurance Claim Form Revision Date 2012 02 01 O M B 0938 1197 O M B Expiration Date 2023 10 31 Downloads CMS 1500 Get email updates Sign up to get the latest information about your choice of CMS topics You can decide how often to receive updates Email Professional Paper Claim Form (CMS-1500) How to Submit Claims: Claims may be electronically submitted to a Medicare carrier, Durable Medical Equipment Medicare Administrative Contractor (DMEMAC), or A/B MAC from a provider's office using a computer with software that meets electronic filing requirements as established by the.

Cms Form 1500 FillablePLEASE PRINT OR TYPE PLEASE PRINT OR TYPE APPROVED OMB-0938-1197 FORM 1500 (02-12) PLEASE PRINT OR TYPE APPROVED OMB-0938-1197 FORM 1500 (02-12) HEALTH INSURANCE CLAIM FORM APPROVED BY NATIONAL UNIFORM CLAIM COMMITTEE (NUCC) 02/12 PICA MEDICARE MEDICAID TRICARE (Medicare#). Back to CMS Forms List CMS 1500 Form Title Health Insurance Claim Form Revision Date 2012 02 01 O M B 0938 1197 O M B Expiration Date 2023 10 31 Downloads CMS 1500 Get email updates Sign up to get the latest information about your choice of CMS topics You can decide how often to receive updates Email