HEALTH INSURANCE CLAIM FORM – HCFA-1500
CMS – 1500 form has 33 Fields. The upper right margin of the claim form should not be used. This area of the claim form is used by the carrier. Any obstructions in this area will hinder timely and accurate processing of claims. The top right margin of the claim form should NOT contain:any type of adhesive-backed labelprinting or headings (including the Medicare carrier address)ink, markers, whiteout, etc.Please print legibly or type all information. Claims may also be computer-prepared.