Billing and Placement of the NPI and Legacy Numbers on the Revised CMS-1500 (08-05) Claim Form An incorporated Solo Provider with one Legacy Provider Identification Number (PIN) and both an Individual National Provider identifier (NPI) number and a Group NPI number, must bill as follows:

This guide is designed to assist with the completion of the CMS-1500 claim form. Submit only the red drop out approved CMS-1500 (02-12) claim form. You may order additional forms at http://bookstore.gpo.gov, or by calling 1-202-512-1800. Details on how to complete the form are outlined on the following pages.

The CMS-1500 form is a critical tool when it comes to correctly submitting healthcare claims efficiently. While filling out any medical billing form, your team should always adhere to the following key principles:

This guide explains what a CMS-1500 form is, how to fill it out, and its importance for accurate reimbursement and patient record keeping.

The 1500 Health Insurance Claim Form (1500 Claim Form) answers the needs of many health care payers. It is the basic paper claim form prescribed by many payers for claims submitted by physicians, other providers, and suppliers, and in some cases, for ambulance services.