Claims
CMS-1500 Preparation Checklist
Checklist to prepare a complete, accurate CMS-1500 professional claim before submission.
This individual form is free to access. No account or email required.
What this form is used for
Walking through every required CMS-1500 (02/12) box so the claim is clean on the first pass.
When to use it
Before submitting any paper or electronic CMS-1500 claim, especially for new staff or new payers.
What to include
- Patient and insured information (boxes 1–13)
- Diagnosis codes and pointers (box 21 and 24E)
- Procedure codes, modifiers, and charges (box 24)
- Rendering, billing, and referring provider NPIs
- Prior authorization or referral numbers when required
Common mistakes to avoid
- Missing or mismatched diagnosis pointers
- Using outdated CPT, HCPCS, or ICD-10 codes
- Leaving required provider identifiers blank
Coming Soon
Medical Billing Forms Toolkit
An organized package of MedicalBillingForms.com templates, checklists, worksheets, and billing resources — coming soon. This individual form is free to use right now.
Learn moreDisclaimer: MedicalBillingForms.com is an independent educational resource and is not affiliated with CMS, Medicare, Medicaid, NUCC, NUBC, or any insurance payer. Official form requirements may change. Always verify current forms, instructions, and submission requirements with the official agency, payer, clearinghouse, or practice policy before submitting claims or using templates.