CMS-1500 Health Insurance Claim
Form Template
This mobile application is a smartphone version of the standard claim form to bill Medicare.
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There are eleven basic data collection screens in the application that track basic patient and insurance information, patient status, illness, hospitalization date, diagnosis, procedures, services, charges and expenses, federal tax ID, patient’s account number, total charge, and total amount paid and balance due. Additionally, this application also allows for signature capture from the physician or supplier and patient or authorized person.
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