View the 1500 Representation

The 1500 representation is rendered from actual claims data imported from your facility. The data is presented in the field locators as it appears on an actual CMS-1500 (formerly HCFA) form.

Use this page to view and print the CMS-1500 information.

Note: This page is shared with Contract Manager Professional.

Procedure

  1. Access the 1500 Representation page.

    If you know the account number:

    • Select Go To > Account Research > By Account Number. The Account Research by Account Number page opens.
    • Type the account number and click Display Account. The Patient Account Audit page opens.
    • Click the CLAIM link in the View column. The 1500 Representation page opens.

    If you do not know the account number:

    • Select Go To > Account Research > from Worklist. The Account Research from Worklist page opens.
    • From the Task list, select Create Worklist.
    • Specify other selection criteria and click Display Accounts. The Account Worklist page opens. For more information about search criteria, refer to Specify Account Worklist Criteria.

      Note: PEM claims are not included in worklist results.

    • Click the account number you want to review in the Account Number column. The Patient Account Audit page opens.
    • Click the CLAIM link in the View column. The 1500 Representation page opens.
  2. To print the 1500 information, click one of the links at the top of the page.
    • Click View Printable Form(s) to display a printable facsimile of the standard 1500 form and its data.
    • Click View Printable Form(s) - Data Only to display a printable page of data from the 1500. This option prints all the information but excludes borders, headings and shading.

      Note: The first time you click one of these two links, the Security Warning page prompts you to install and run the “Form Printing Assistant.” You must click Yes on this page to print the 1500 information correctly.

      The Printing Assistant adjusts several Internet Explorer print settings (margins, background color printing, headers and footers) so that your CMS-1500 prints properly. When you leave the page, the Printing Assistant returns the Internet Explorer print options to their original settings.

  3. Click Back on the menu bar to return to the previous page.