Search Frequenty Asked Questions

PLEASE READ CAREFULLY: IMPORTANT INFORMATION

If you intend to make paper copies of the attached Form CMS-1500 (in PDF) for claims submission purposes, please contact the specific health care payer that you intend to submit these claims to before submitting these claims for payment. Some payers may be able to accept a black & white copy of Form CMS-1500. Other payers may not accept a black & white copy if they are utilizing Optical Character Recognition (OCR) equipment.

Specific Instructions For Medicare

If a Medicare carrier utilizes Optical Character Recognition (OCR) equipment to process Form CMS-1500s, then the provider or supplier must submit these forms using the scannable, red-ink version of Form CMS-1500. These red-ink versions of Form CMS-1500 can be purchased from the U.S. Government Printing Office at 202-512-1800 or from a local printer in your area. Please note that the red-ink used to print Form CMS-1500 (i.e., exact ink is Sinclair Valentine J6983, OCR Red or Equal) cannot be duplicated by your PC printer. Therefore, if you attempt to print red-ink versions of Form CMS-1500 from your PC printer, our Medicare carriers will not be able to process your claim.

Good News: There are some Medicare carriers that will accept "black & white" copies of Form CMS-1500.

If a Medicare carrier is not currently utilizing OCR equipment to process claims, they may accept Form CMS-1500 facsimiles that are generated by dot matrix or laser jet printers as long as the originals are submitted for payment.

If a Medicare carrier accepts "black & white" copies of Form CMS-1500, the back side of the form does not have to be printed and submitted with each claim if the provider or supplier files with their Medicare carrier a signed statement indicating that he or she has read the reverse side of Form CMS-1500, understands the requirements and agrees to comply with applicable Medicare billing requirements. This statement must be filed by the provider or supplier and sent to the carrier on an annual basis.

Please note though that if a Medicare carrier is not currently utilizing OCR equipment, but decides to use it in the future, the Medicare carrier may require providers and suppliers at that time to submit Form CMS-1500s using OCR processable forms.

Please contact your local Medicare carrier and ask them whether or not they accept "black & white" copies of Form CMS-1500. If they do accept "black & white" copies, ask them for details regarding the certification statement. If you do not know the phone number of your local Medicare carrier, go to http://www.CMS.HHS.gov/regions/default.asp and click on the State you reside in.

Get The Form CMS-1500 Here.