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Web cms 1500 dynamic list information. Web revised cms 1500 claim form, version 02/12. Read the instructions and tips below first. Web we are authorized by cms, champus and owcp to ask you for information needed in the administration of the medicare, champus, feca, and black lung programs.

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The following provides access and/or information for many cms forms. Insured’s name (last name, first name, middle initial) 7. Form version 02/12 will replace the current cms 1500 claim form, 08/05, effective with claims. Web you can generate cms 1500 claim forms to submit electronically, or download and print completed forms to submit outside of simplepractice.

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