1500 v0805 Form

Use the 1500 v0805 Form to print billing claims in the standard, Health Care Financing Administration (HCFA) v0805 format of the 1500, based on the criteria you select:

1.    Click the arrow beside the Offices field, and then select the check box beside the office you want to use. To see all offices, click the top-level check box.

2.    Click the arrow beside Payor and select the appropriate payor source, or select All Payors to display all the payor sources.

3.    Change the following fields to filter by specific items other than the default settings:

●     The Service From and Service Thru dates include the previous month's service dates. To filter by any other dates, click in the Service From and Service Thru fields and select the appropriate dates from the calendars.

●     The Patient Last Name From and Patient Last Name Thru fields contain All to include all patients in the report. To filter the report by a specific patient, or a range of patient names, enter the range of names in these  fields.

●     The Patient First Name From and Patient First Name Thru fields contain All to include all patients in the report. To filter the report by a specific patient, or a range of patient names, enter the range of names in these  fields.

4.    Click Preview. Depending on what type of browser you use, you may see a message asking if you want to open or save the file. If you select the save option, the system prompts you to select a location where you want to save and name the file.

5.    Click Open.

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