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BECAUSE THIS FORM IS USED BY VARIOUS GOVERNMENT AND PRIVATE HEALTH PROGRAMS, SEE SEPARATE INSTRUCTIONS ISSUED BY. Mail completed forms to: Department of Labor and Industries. PO Box 44269. Olympia WA 98504-4269. F245-127-000 CMS 1500 02-2012 . May 12, 2012 – I am looking for a template to complete CSM 1500 health insurance claim forms and print to a standard pre-printed (single sheet) CMS 1500 (red) claim. The template could be for MS Word or for MS Excel. . Is there a special reason you want it in Word or Excel format? Fill nucc org 1500 claim form 2012-2018 denise instantly, download blank or editable online. Sign . Search. Fill cms 1500 claim form template: Try Risk Free. The CMS-1500 form is the standard paper claim form used by a non-institutional provider or supplier to bill Medicare carriers and Medicare administrative . Download the Fillable HCFA 1500 Claim Form that is both a fillable and/or printable medical claim form that will provide insurance, illness and injury information . Nov 10, 2016 – How to Submit Claims: Claims may be electronically submitted to a Medicare carrier, Durable Medical Equipment Medicare Administrative . Form #: CMS 1500; Form Title: Health Insurance Claim Form; Revision Date: 2012-02-01; O.M.B. #: 0938-1197; O.M.B. Expiration Date: 2020-03-31; CMS . Page 1. PLEASE PRINT OR TYPE. APPROVED OMB-0938-1197 FORM 1500 (02-12)