Instructions:

The following case study is for patient Coleman Parker.  Complete the CMS-1500 claim form for this patient who has both group insurance through his wife's employer and Medicare.  This will provide you an opportunity to work through the process of submitting a CMS claim form when there is more than 1 insurance provider.

Assignment: 

 1. Review the following documents: 

  2. Open and complete the following document: CMS - 1500 claim form (PDF Download).

  3. Submit the completed document following these steps:

NOTE: If you do not follow these steps exactly, your form will not save the information that you have embedded into it.