Create CMS-1500 Claims

A CMS-1500 form, previously known as a HCFA form, is a paper claim that you can generate through TherapyNotes and print and mail to the payer for reimbursement. TherapyNotes allows you to easily create and print CMS-1500 claims to send to payers using your choice of pre-printed red CMS-1500 forms or printing the red form background with your claim.

For payers who do not require paper CMS-1500 claims, we highly recommend submitting claims electronically using TherapyNotes electronic data interchange (EDI). For more information, read Submit Electronic Claims.

Role Required: Practice Biller

CMS-1500 Printing Options

When generating a CMS-1500 claim, TherapyNotes allows you to choose to print your data onto pre-printed red forms or print the red form background along with your data. CMS-1500 forms can be purchased from a variety of places and may be required by some payers. Adjust your printing settings to make sure the data you print lines up correctly with the pre-printed form.

Configure CMS-1500 Printing Options for Your Practice

Note: Practice Billers and Practice Administrators can configure Practice Billing settings.

Click the User Icon > Settings > Practice Billing
Under Paper Claims, configure how you want CMS-1500 forms to be printed.
Click the Save Billing Settings button.

Tip: For best results when printing on pre-printed CMS-1500 red forms, print in high quality and use a paper tray rather than a document feeder - a paper tray tends to feed paper to the printer more evenly. If the content of the CMS-1500 isn't aligned with the pre-printed form, adjust the margin offsets and click Generate Test Form Using These Settings to print a test form.

Creating CMS-1500 Forms

CMS-1500 claims can be generated once a clinician completes and signs a billable note for a client who is set up to bill their insurance. The bubble next to Create CMS-1500 throughout TherapyNotes (such as on the main Billing page and on your To-Do list) will display the number of CMS-1500 claims that are ready to be submitted.

Before creating a CMS-1500:

Click Patients > Patient Name > Patient Billing tab
Under Search Billing Transactions, click the date(s) of service you want to create a CMS-1500 for.
Verify that the Method for the corresponding date(s) of service is set to Insurance - In Network - Paper OR Insurance - Out of Network - Paper. For additional guidance, read Set Billing Method.

To generate a CMS-1500 form:

1) Do one of the following:

Click To-Do > Create CMS-1500 forms OR
Click Billing > Create CMS-1500 OR
Click Payers > Payer Name > Billing tab > Create CMS-1500

2) Under Search Billing Transactions, click the bold Pending Paper or Resubmit Paper link next to the date of service you want to bill for.

Tip: To submit CMS-1500 forms for a specific client, click Patients > Patient Name > Patient Billing tab > Create CMS-1500. This automatically lists all dates of service for the client that are eligible for paper claim submission on the Create CMS-1500 Form page.

(A) Include on CMS: Select the checkbox next to the dates of service you want to include on the CMS-1500. TherapyNotes batches up to six dates of service per client on a single CMS-1500.

(B) Document Format: From this dropdown, select whether you are using pre-printed CMS-1500 forms or you are printing the red background with the rest of the content of the CMS-1500.

3) Click the Download CMS-1500 button. The CMS-1500 will download as a PDF.

4) TherapyNotes will prepare your document in a blue bar at the bottom of your browser. When your CMS-1500 is ready, click the Ready: Click to Download link.

To create a CMS-1500 claim for a secondary payer, read Secondary Insurance.

Tip: While some payers will accept a CMS-1500 form with a black-and-white background, other payers may reject claims that do not include the standard background in red ink. For this reason, we do not recommend printing CMS-1500 forms in grayscale. To reduce the likelihood of claim rejections, use pre-printed CMS-1500 forms or use a color printer with red ink to print your CMS-1500.

Next Steps

Review the CMS-1500 carefully before printing and mailing to the payer. Mail the completed CMS-1500 form to the payer's paper claims address.
Once you receive reimbursement from the payer, enter the insurance payment in the TherapyNotes. To learn more, read How To: Enter Insurance Payments.
If you are enrolled to receive electronic remittance advice (ERA) from the payer, post the ERA payment to TherapyNotes. To learn more, read Post ERA Payments.