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PDF SmartForm Features:
1. Fill in the CMS-1500 (08/05) claim form by entering information into user-friendly dialog boxes. The dialog boxes logically group similar claim data together. Dialog boxes greatly assist the user in filling in the form. In the interest of speedy data entry, all form data is automatically converted to OCR-friendly UPPERCASE.
2. The CMS 1500 SmartForm is a layered pdf with dialog boxes for entering information. There is no need to understand the complexities of the underlying form field layout. Achieve perfect placement of data onto the form every time.
3. Use drop-down lists to select codes and simplify data entry. The drop-down lists contain HIPAA-compliant codes and their descriptions! Only the actual code is placed onto the form.
4. Print, email, save, and export the data using the free Adobe® Reader® software. Create time-saving claim form "templates" by pre-filling information and saving to any number of form template files.
5. Integrate into email workflows by exporting only the form's data as an XFDF file < 20 KB in size!  Any XFDF data file can be viewed using a single copy of the SmartForm. Since the XFDF file is so small, file system or database storage requirements are also very practical. Backup and transport thousands of claims on your portable USB memory stick!
6. The SmartForm is not a scanned image placed into a pdf file. The SmartForm template is a pdf containing high-performance/resolution-independent vector objects and type scaled to match the pre-printed official red CMS-1500 paper form's dimensions. The template's text is fully searchable. The form's "template text" was created in Adobe® Illustrator® CS2 using the official, cross-platform Helvetica OpenType font. The font used for the form's data is the OCR friendly, NUCC recommended - Courier size 10 font. The CMS-1500 pdf form template alone is worth the $45 per form cost.
Warning! Geek Speak: The form can also be used as a "template" by backend systems needing to populate CMS-1500 forms from data stored in relational databases. The form's fields and code are not "locked down" in any fashion whatsoever. The form's javascript source code and form fields are accessible to anyone with Adobe® Acrobat® installed on their computer. Programatically populate the perfectly-scaled form template and provide sharp, crisp CMS-1500 forms to users at any screen resolution. In the past, we have used backend programmable server products such as activePDF Toolkit to accomplish this for clients with great success. End of Geek Speak!
7. Data entry is achieved through the use of sophisticated, high-performance dialog boxes. Control buttons, tabbing and drop-down lists make entering data a snap. This de-coupling of data entry from the form is very powerful. An example of this flexibility is the existence of a reset button in each dialog box. The user can clear data in a particular area on the form while leaving data elsewhere on the form intact. This ability to clear data from particular areas on the form is great for creating time-saving templates.
8. Our layered PDF SmartForm allows the user to print only the form's data onto official red pre-paid CMS-1500 (08/05) forms. One can also print the entire form including the form's red boiler-plate template text to any printer.
9. The PDF file format and Adobe® Reader® allow strong security to be applied at the document level. The PDF file format is a rich container that can contain many different types of file formats. PDF/A is the United States Government's official electronic document archival format. The PDF/H file format is being considered as a future format for electronic medical records by standards organizations such as AIIM.
* All sales of the CMS 1500 SmartForm are final.
Featuring the new fillable CMS-1500 (08/05) PDF SmartForm. Only $45! Download and start using your licensed copy today!
Stop filling out your CMS-1500 claim forms by hand! Fill out and submit the new CMS-1500 (08/05) medical claim form using our CMS-1500 PDF SmartForm and the free Adobe® Reader®.

 

Now works with the new Adobe Reader 9! Also works with Adobe Reader versions 7 through 8. Works on Windows and the Mac!

The CMS-1500 SmartForm can simplify professional medical billing and increase "clean claim" submission rates. The CMS-1500 SmartForm allows you to fill in, print, save, secure, fax, email and transmit professional medical claims. Print only the form field data to your pre-printed, official red CMS 1500 forms. The claim data can also be saved or exported in a variety of formats including PDF, XML, and XFDF.
  1. The CMS-1500 PDF SmartForm is a simple but powerful solution. The solution consists of a single, self-contained, interactive PDF file requiring only the free Adobe® Reader® software. Start filling out the new CMS-1500 (08/05) forms today!
  2. Can't read someones handwritten claim form?
  3. Is data placement onto your red, pre-printed CMS-1500 forms inaccurate or not aligning properly?
  4. Are faxed forms blurry, difficult to read, slow and labor intensive to process?
  5. Your current software generates a form based on the old HCFA-1500 (12/90) form and you need a solution containing the new NPI and split service line fields found on the newer CMS-1500 (08/05) form?
  6. Want an electronic solution that can eliminate the re-keying of information into many different systems?
  7. Do you prefer a simple, document-centric form solution as opposed to an expensive, sometimes confusing software application?
  8. Want to include claims as documents in a secure, email-based workflow?
  9. Want to include claims attachments (CMN's, lab reports, images, etc.) with your CMS-1500 form in a single, multi-document PDF file? (possible with Adobe® Acrobat® and our SmartForm).
  10. Need a drop to paper backup solution for your claims management system?
  11. Are you a payer, clearinghouse or repricer who would like more control of the claim data entry interface in order to raise your "clean claim" submission rates?
  12. Need strong claim document security in the form of password-protection, electronic signatures and document encryption?
  13. Is your current claims management software too costly, complex and inflexible?
Our CMS-1500 PDF SmartForm can meet all these requirements and much more! Click the Start> button located in the upper left hand corner of our SmartForm and begin. It's that simple.
Mass distribute the CMS-1500 SmartForm to anyone who has the free Adobe® Reader® software and start sending and accepting cleaner claims in the data format of your choice today!
"Experience simplified and more accurate claim data entry using our assistive form dialog boxes and drop-down code lists."
A PDF SmartForm is a special type of interactive pdf file where data can be entered and saved using the free Adobe® Reader® software. The SmartForm is NOT a black and white scanned image of a CMS-1500 form with a bunch of pdf form controls just "thrown" onto it. Our layered, high-performance pdf form template and assistive data entry dialog boxes make this pure PDF-based form solution truly unique!
Our forms are rich in features and intelligence. The SmartForm approach offers the best of both worlds: paper and electronic. The CMS-1500 SmartForm is the electronic representation of the official red pre-printed form. The PDF SmartForm's data is placed onto the form in the OCR-friendly Courier 10 point font. The NUCC's (National Uniform Claim Committee) CMS-1500 billing guideline rules for properly formatting and placing claim data are an integral part of the CMS-1500 SmartForm's validation and data placement logic.
A PDF SmartForm requires no software installation! There are no expensive software upgrades or intrusive software activation steps to take. It is a single self-contained pdf file ready for use. The CMS-1500 PDF SmartForm works on both the Microsoft® Windows® and Macintosh® operating systems.
If you are a:
  1. Medical Biller
  2. Healthcare Provider
  3. Payer
  4. Clearinghouse
  5. Claims Repricer
  6. IT Manager
  7. Non Profit Organization
  8. Government
  9. Business
  10. PDF Form Developer**
    **Hundreds of lines of high-performance Javascript code.
- Or anyone else who needs to submit medical claims in either paper or electronic formats, this PDF CMS-1500 SmartForm may be a perfect, low-cost solution that can meet your needs. Purchase your CMS-1500 PDF SmartForm today!
CMS-1500 PDF SmartForm (universal license): Only $45.00


* Call for special pricing for site licenses or for CMS-1500 PDF SmartForm customizations.

  1. We are committed to providing the medical billing industry with a non-proprietary, low cost professional medical claim billing solution.
  2. The high quality CMS-1500 PDF SmartForm template alone is worth a $100, easy!
  3. And if you are a PDF form developer, the hundreds of lines of Javascript code that "bind" the dialog box fields to the underlying form fields are estimated to be worth hundreds of dollars in development time.
News: The UB-04 PDF SmartForm, used for institutional claim submission, is under development.
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