4.4 Creating a Claim

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With SimplePractice you can generate CMS 1500 forms in a few simple steps! We've divided this article into three sections. Just click on these links to jump to the right section.

 

First Time Checklist

The first time you create a CMS claim form for a client, you’ll want to make sure you’ve entered the required data. Here are the three things to make sure you’re getting it right:

1. Make sure you’ve filled out your personal and practice information in your settings.

  • Go to My Account > Settings > Basic Info > Clinical Info > enter your personal NPI there.
  • Go to My Account > Settings > Practice Settings and enter your practice name, address, etc...).
  • Go to My Account > Settings > Billing > enter your Organization NPI here. If you don't have a Group or Organization NPI, leave blank. Also in this section, make sure you've entered the EIN that is associated with that Group NPI. If you don't have a group NPI and you'll be billing using your personal NPI, you'll need to enter your SSN if that's what's associated with it.
  • Go to My Account > Settings > Billing > Insurance > make sure the Individual or Organization options are selected depending on how you're billing and that the address in box 33 is the billing address the payer has on file for you.

 

2. Make sure your client's demographic and insurance information is set correctly. Most times this is done during the intake process. To check on this, click on edit client info. Required fields are the client's insurance insurance company, insurance Member ID, gender, birthday, phone number, and address. For more information about selecting your client's insurance company from the drop down list, check out this article: Selecting the right insurance provider and payer for your client.

3. Make sure that you’ve entered a Primary Diagnosis for the client as well as set the appropriate CPT/Billing codes and rates for the client appointments. Click here to learn how to create a diagnosis.

 

Creating a CMS form

Once you've checked this information, you're ready to create a CMS claim form.

1. Go to the Client Billing page. You can access it from the Client Profile page. You can also reach the Client Billing page from the session flyout on the calendar.

2. Once you're on the Client Billing page, set the date range for the sessions you would like to include on the claim form. For example if you want all session in July, set the date range to 7/1/2016 to 7/31/2016.

3. Click the blue +Create button and select Claim/CMS1500.

4) This will open up an editable form with all the CMS fields. Review the pre-populated information and add or edit any fields necessary. Don't worry, this isn't what the CMS form will look like when printed. The layout on this form is just for editing purposes.Your CMS Claim form prints just like a normal CMS form.

For more information on pre-populating additional CMS fields, check out this article.

5) Once you have reviewed the information, you are ready to submit your claims. You have two choices:

Electronic Claim Filing

If you're already enrolled, you'll see a blue Submit button at the top of the form. Click this to submit your claim to the insurance company. Click here to learn how to file a claim.

Filing outside of SimplePractice

If you prefer to file the claim outside of SimplePractice, click the blue Save button at the top of the form. This will save the claim to the Client Billing page.

 

Printing the CMS form

1. To print or download the claim form to file it outside of SimplePractice, click the Download button at the top of the CMS 1500 claim page.

2. A modal will pop up giving you two options:

Download with form background will generate the fully filled out, red CMS 1500 form as a PDF.

Download with form fields only will download only the data fields so you can print them out onto your own pre-printed CMS 1500 form. You can print it on your own blank CMS.

When printing out either form, make sure the printer does not scale the page or add margins. If you print from Adobe Acrobat, these defaults should be set automatically.

Printing tips

When printing out the full claim form with the red background, make sure your red ink cartridge is full and the red background prints without any streaks or faded color.

When printing the data directly to a pre-printed claim form, we recommend adding the pre-printed claim form to your printer's main paper tray and not trying to print the form from an auxiliary paper tray.

Remember that each printer is different so if your data fields don't print perfectly to the pre-printed claim form, you may have to tinker with the way you load the pre-printed forms in the paper tray and try the process again.

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