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completing the CSM 1500 claim form


Correctly Completing Private Payer Claims

The objective of these exercises is to correctly complete private payer claims, applying what you have learned in the module.

In order to complete the claims you will need the following:

  1. Case Information which includes the Provider Information, Patient Information, and the Encounter Information.
  2. Fillable CMS-1500 Claim Form
    • Download this fillable CMS-1500 form and use it for filling in and saving a claim form for each case.
    • You can fill in this version of the form electronically, using Adobe Form Filler, as long as you have Adobe Acrobat Reader. (If you need the latest version of the free reader, you can download it from via the internet.) Note: Do not try to complete the form within your browser. First, save the file to your computer. Once you have completed the form, be sure to select “save as” from the File menu and re-name the file per the instructions below.

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