Creating CMS 1500

Medplum supports customizable creation of CMS 1500 for use in billing.

The CMS 1500 form is a standardized form used in the United States to submit healthcare claims to Medicare and other health insurance providers. It is widely used by non-institutional providers and suppliers, such as physicians and outpatient clinics, to bill Medicare Part B and other insurers for services provided to patients. The CMS 1500 requires information about the patient, the medical services provided, and their costs.

Medplum supports generating the CMS 1500 form as both plaintext and PDF, using a Claim resource as input. The plaintext approach maps claim data to the corresponding fields on the form and outputs a comma-separated text line suitable for use in a CSV file. The PDF approach formats the claim data into a structured PDF document, following the official CMS 1500 template with all fields positioned according to specifications.

CMS 1500 and FHIR

The data that fills the content of the CMS 1500 lives (largely) on the Patient, Coverage, Claim and Encounter FHIR resources. Your charting process should accurately populate these resources to ensure streamlined billing.

Commonly, the generation of the CMS 1500 is linked to the finalization of the encounter, for example when an Encounter.status is finished, a CMS 1500 is created and synchronized to clearinghouse or billing service. Creating a Subscription where the criteria is status=finished is a minimum implementation of this workflow. It is recommended to have implement generation of the CMS 1500 as a bot.

Synchronizing Data

Data will need to be synchronized to a clearinghouse to initiate the claims process.