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Tools & forms: Claims

Tools

ADR Timeliness Calculator

CMS-1500 Interactive Form

Part A Credit Balance Status

Part A Reason Code Lookup

Forms

Use SPOT to submit electronic claims, credit balance reports, and more. Learn how to register

Form Description

Medicare Part A PWK fax/mail/esMD coversheet

Medicare Part B PWK fax/mail/esMD coversheet

 Use this PWK coversheet for voluntary submission of supporting documentation with a version 5010 electronic claim. Learn more.

Part A JN hardcopy request form

 

 Use this form before doing a hardcopy claim submission - Part A only

  CMS-1500 (02/12) Part B paper claim form

 Most claims for Medicare Part B services require electronic submission. Learn more about instances when a paper claim form is permissible.

CMS-1450 | UB-04 Part A paper claim form

 This form may be used by an institutional provider to bill Medicare when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims.

Additional resources