CMS 1500 Claim Creation, Submission & Status Tracking
Manually create a CMS 1500 insurance claim from a six-section form that pulls client, billing, and provider information from existing profiles, then submit it as a PDF, a TXT export to a clearinghouse, or directly through a connected clearinghouse like Claim.MD or Office Ally. Track every claim's status (Sent, Batched, Rejected, etc.) from a filterable CMS 1500 Dashboard, and log reimbursement and co-pay details per claim. Works alongside Automated CMS 1500 Claim Generation for practices that also auto-create claims overnight.
Built by Core Engineering
The problem it solves
Creating an insurance claim from scratch for every client, and then separately tracking its status and reimbursement, is slow and easy to lose track of across a caseload. This solves that by pre-populating claim data from existing client and provider records and giving every claim a trackable, filterable status through to reimbursement.
What's included
- Six-section CMS 1500 form generator, pre-populated from client profile and prior claims
- Three submission paths: PDF download for mail, TXT export for manual clearinghouse upload, or direct clearinghouse submission (Claim.MD, Office Ally)
- Secondary claim support, selecting a client's secondary policy and referencing the primary claim number
- Filterable CMS 1500 Dashboard with claim status (Sent, Batched, Rejected by Clearinghouse, and more)
- Per-claim reimbursement details and co-pay amount tracking, with client-owed amounts flowing automatically into an associated invoice
- ERA (Electronic Remittance Advice) claim detail view with CARC/RARC remark codes for Claim.MD-connected accounts
- Organization-level permission to view claims across other providers, not just one's own
How it works
A provider creates a claim from Insurance > CMS 1500s > New CMS 1500, selecting a client; required fields are validated before the claim can be created, and information from any prior claim for that client pre-fills. To file a secondary claim, a provider follows the same steps but selects the client's secondary policy instead of primary, typically noting the primary claim number under Original Reference Number; some payers require the primary EOB to be attached, which isn't supported within Healthie, so exporting as TXT to attach via the payer's own portal is the workaround. Once complete, the claim can be downloaded as a PDF for physical mailing, exported as a TXT file for manual upload to a clearinghouse, or submitted directly through a connected clearinghouse integration. Claims appear on the CMS 1500 Dashboard, where a provider can filter by status, by provider (with appropriate organization permission), and update a claim's status as it moves through the clearinghouse and payer review process, logging co-pay and reimbursement details as they come in; setting Reimbursement Details on a claim automatically populates the client-owed amount into an invoice associated with that claim. For accounts connected to Claim.MD or Office Ally, claim status and reimbursement details update automatically as ERA (Electronic Remittance Advice) data arrives, and eligible claims show a "Claim details (ERA)" view with line-item payment data plus CARC/RARC remark codes explaining how a claim was adjusted or denied. This manual and review workflow works alongside Automated CMS 1500 Claim Generation, since auto-created claims land in this same dashboard for review before submission; the CMS 1500 Report and Payments Report are the recommended way to regularly reconcile outstanding claims and payer reimbursements.
This covers the manual side of CMS 1500 claim creation: building a claim from a six-section form (client information, diagnosis, billing items, billing/provider information, and more) that pre-populates from the client's profile and any prior claims on file, then submitting it to an insurance payer. It's built for practices that create claims individually, review auto-generated claims, or need submission flexibility beyond automatic overnight generation. A completed claim can be downloaded as a PDF for mailing, exported as a TXT file for manual clearinghouse upload, or sent directly through a connected clearinghouse integration like Claim.MD or Office Ally. Every claim's status can be tracked and filtered from the CMS 1500 Dashboard, with reimbursement details, co-pay amounts, and clearinghouse rejection reasons logged per claim.