Electronic Up Module 10 Project - Complete an Electronic Claim Form

In an ambulatory care setting, in order to bill insurance companies, you need to complete a CMS-1500 claim form. The information from an encounter form, Superbill, or charge ticket is entered on the claim form to charge for office visits and services. If you are completing an electronic claim separate from those in an electronic health record, your computer must be in caps lock mode. You should not use any punctuation marks in sections 1-13, which is the patient and insured's information. Click here for a sample claim form. In the real world, this form is printed out, SOF (signature on file is written in box 13 and 14), the physician signs the form, and the carrier's information is completed on the top of the form, and then the form is mailed.

Click on the following encounter form link to complete the electronic claim form.

1. Encounter Form
2. Electronic Claim Form