Create Health Insurance Claim Form 1500

Health Insurance Claim Form 1500: What Is It?

This form is used by the San Mateo County Health System in California. The Health Insurance Claim Form 1500 is used to submit a claim to a health insurance company in this county. This form will allow an insurance company to determine whether or not a medical appointment or treatment is covered under the insurance program. These insurance programs could include Medicare, Medicaid, or Tricare.

This form will require information about the patient who received medical care. This includes their identifying information and health insurance policy number. After this, the information about the medical visit is needed. This includes the dates of service, what the visits were for, and what the diagnosis and treatments were. This information may be cross-checked with the health care provider, so be sure you have all the correct information before filling out the form.