A CMS-1500 claim form is an official Medicaid and Medicare health insurance claim form, which is required by the Centers for Medicare & Medicaid Services of the U.S. Department of Health and Human Services. It is usually used by non-institutional health care suppliers or providers to charge Medicare carriers.
A CMS-1500 claim form also is used to bill some state Medicaid agencies. Claims must be submitted on original print forms, not photocopies, to ensure proper reading of OCR-scannable red ink. Providers can purchase the forms online or from Medicaid and Medicare offices. The form, created by the independent National Uniform Claim Committee, is available in quantities and in various formats including one-part, two-part and two-part snap-out versions.