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CMS 1500 Forms

Things move fast in your organization. CMS 1500 Forms lets you confirm the accuracy of practice settings and information before submitting a bill.

Step 1. On the navigation bar, click ‘Billing Providers’, then select ‘Manage Billing Providers’

The Manage Billing Providers feature is limited to users with the Role of Organization Admin.

Step 2. Click the ‘Billing Provider’ name

For DaisyBill accounts with multiple Billing Providers, DaisyBill maintains separate CMS 1500 Forms for each Billing Provider.

Step 3. Click the ‘CMS 1500 Forms’ card

A green ‘Checkmark’ icon in the lower right corner of the card indicates CMS 1500 Forms have been previewed for the Billing Provider.  A red ‘X’ icon indicates no CMS 1500 Form has been previewed.

Step 4. From each drop-down list, select the ‘Rendering Provider’, ‘Place of Service’ and (optional) ‘Referring Provider’

The information selected will be used to populate the CMS 1500 Form preview using dummy bill information.

Step 5. Click the ‘Preview CMS1500’ button

This downloads a sample claim form in PDF format. Take a look and make sure your information is correct.

All set? Happy billing!

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