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CMS-1500 Form
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Healthcare Claims
The world's best CMS-1500 extraction
Accelerate revenue cycle management and claims processing. Digitize professional health claims (Box 1-33) with high-precision ICD-10 diagnosis codes and CPT procedure codes. Built-in NPI validation ensures provider legitimacy using the standard Luhn algorithm.
cms-1500.pdf
Viewer
JSON
patient_name
Jane M. Rodriguez
patient_dob
1985-03-22
patient_address
789 Health Street, Austin, TX 78701
insured_id_number
XYZ123456789
insured_name
Jane M. Rodriguez
insurance_plan
Blue Cross Blue Shield
Diagnosis_codes
2 items
sequence
icd10_code
description
1
J06.9
Acute upper respiratory infection
2
R05.9
Cough, unspecified
Service_lines
1 item
date_of_service
place_of_service
cpt_code
modifier
diagnosis_pointer
charges
units
2024-01-15
11
99213
1,2
150
1
total_charges
150
billing_provider_name
Austin Family Medicine
billing_provider_npi
1234567890
billing_provider_address
456 Medical Center Dr, Austin, TX 78702
rendering_provider_npi
0987654321
cms-1500.pdf
Viewer
JSON
patient_name
Jane M. Rodriguez
patient_dob
1985-03-22
patient_address
789 Health Street, Austin, TX 78701
insured_id_number
XYZ123456789
insured_name
Jane M. Rodriguez
insurance_plan
Blue Cross Blue Shield
Diagnosis_codes
2 items
sequence
icd10_code
description
1
J06.9
Acute upper respiratory infection
2
R05.9
Cough, unspecified
Service_lines
1 item
date_of_service
place_of_service
cpt_code
modifier
diagnosis_pointer
charges
units
2024-01-15
11
99213
1,2
150
1
total_charges
150
billing_provider_name
Austin Family Medicine
billing_provider_npi
1234567890
billing_provider_address
456 Medical Center Dr, Austin, TX 78702
rendering_provider_npi
0987654321
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