Screenshot of CMS-1500 PDF (02/12) Type, Print & Save your claims
using Adobe Reader software

The 1500 Form Filler is ideal for fast submission of the standard paper claim used by health care providers to bill for services. 

The newly revised form allows for ICD-10 reporting, and brings uniformity with the current health care claims requirements.
CMS-1500 VideoSee a quick video here

Download the Demo Here

User Highlights

•  Easy - Just like the CMS-1500. Simply type in the form fields using Adobe Reader.
•  Efficient - Create unlimited claims. Save & re-use your templates over and over.
•  Affordable - One-time purchase. Install on up to 2 computers such as home and office.
•  Optional Form Calculations - Automatically adds up all the charges for you.

Printing Text Only - Put a Commercially Printed 1500 (02/12) Paper Claim in the printer and choose Print Text Only from the menu. The form is aligned to place the text in the proper spaces.

Printing Form and Text - Open the CMS 1500 PDF and fill in the patient information. In the menu choose Print All. This option will print the red form with typed text with the back page.
Note: It may not be possible to replicate the form color (OCR Red, Flint J-6983) with your printer. We recommend sending a sample first, or print "Text Only" to ensure your claim is accepted.

System Requirements - This fillable PDF requires Adobe Reader 9 or greater to type, save and print form fields. Download the latest version of Adobe Reader, the free, trusted standard for PDF files. 

Fiachra Forms offers individual support at any time, through video tutorials, a community forum, and detailed email responses for any issues that you may encounter. Customer Comments:

User License
Purchase of the CMS-1500 PDF entitles the user to perpetual use of the form, for an unlimited amount of time. A licensed user may open, use, access, display and copy the CMS-1500 PDF on up to two (2) computers. This license may not be shared, transferred or used by others. If your agency needs additional user licenses, the purchaser must be willing to manage the deployment and utilization of each license of the CMS-1500 PDF within the agency.