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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


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
SequenceIcd10 codeDescription

1

J06.9

Acute upper respiratory infection

2

R05.9

Cough, unspecified


Service lines
1 item
Date of servicePlace of serviceCpt codeModifierDiagnosis pointerChargesUnits
Jan 15, 2024

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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DocuPipe captures CMS-1500 forms from clearinghouses, fax-to-email, or scanned batches. Extract patient info, diagnosis codes, service lines, and provider details, then sync to practice management systems, EHRs, or claims processing platforms.

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