Create a HCFA 1500 Form in less than 5 minutes
Legally binding in all 50 states
Print and export to Word or PDF in seconds
A HCFA 1500 form is used by the Health Care Financing Administration. It is used for health care claims. It is used to submit a bill or charge for health insurance coverage. This could be through Medicare, Champus, group health care, or other forms of insurance.
Detailed information about the medical treatment will be required. It should include the injury or the medical condition that prompted the medical attention. The date of medical service is needed, as well as the names of the attending physicians. The charges for the medical services can be listed in a table on the form.
The policy information for the health insurance must be included on the form as well. This includes the policy number, group number, the policy holder's name, and more. If the insurance is through an employer or a school, this information is also needed.
Click here to get started now!