Stedi automatically generates a PDF CMS-1500 claim form for each professional claim you submit.

We strongly recommend reviewing the following behavior and recommendations if you plan to send these PDFs to payers or retain them for your records.

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Retrieve PDFs

You can manually download generated any claim’s generated CMS-1500 PDF from the transaction details page for the claim in Stedi.

You can also retrieve PDFs through either of the following endpoints:

  • CMS-1500 PDF: Business Identifier: Retrieve PDFs through a claim’s business identifier. You can find the business identifier value in the claimReference.correlationId property Stedi returns in the synchronous claim submission response.
  • CMS-1500 PDF: Transaction ID : Retrieve PDFs through the transactionId Stedi assigns to the processed claim. This ID is included in the transaction processed event for the claim, which you can receive automatically through webhooks. You can also retrieve this ID from the transaction’s details page in Stedi.

Both endpoints return a base64 encoded string of the CMS 1500 Claim Form PDF. To render the PDF, you must decode the base64 string and save it to a file with a .pdf extension.

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Generation notes

Note the following behavior and recommendations to generate optimal CMS-1500 PDFs.

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PDF background

You can generate CMS-1500 PDFs with a white background by adding the query parameter ?background=false when calling the PDF generation endpoints.

The National Uniform Claim Committee (NUCC) and CMS provide exact specifications for blank CMS-1500 forms, including paper size and ink color. Many provider offices are accustomed to using these pre-printed forms, and their Practice Management System (PMS) applications are designed to print claim data onto them. Generating PDFs with a white background allows you to print the claim data directly onto official pre-printed forms.

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The PDF may truncate claim data.

The maximum length for many fields in the 1500 claim form is less than the maximum length for the corresponding properties in the claim request.

Recommendation: Ensure that your claim data is within the maximum length for claim form fields. We especially recommend using USPS abbreviations to avoid truncated addresses in the generated PDF.

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The PDF may omit the second line of some addresses.

Some 1500 claim form items contain address fields that can only be mapped to a single address line. If you include the address2 JSON property (X12 EDI N302) in your claim submission, that information may not appear in the PDF.

Recommendation: Put all street address line data into the address1 JSON property (X12 EDI N301), ensuring that you adhere to the claim form length constraints.

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The PDF won’t populate Item 7 when the patient is a dependent.

Stedi validates the claim data you submit to the API and uses it to generate a compliant X12 EDI transaction to send to the payer. The PDF is generated from the final X12 EDI transaction.

The X12 EDI standard specifies that claims should only contain the insured’s address when the patient is the subscriber. To maintain compliance, Stedi doesn’t include the insured’s address information in the generated X12 EDI transaction when the patient is a dependent, even if you provided the subscriber’s address in the original API request. Since this address information isn’t present in final X12 EDI claim, it’s also not added to Item 7 (Insured’s Address) in the generated PDF.

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Payer address (Carrier Block)

You can populate the payer’s address on the PDF by providing the payerAddress object in your claim submission API request. Include the payer’s address details that you want to appear on the form.

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Standard form size

The generated PDFs use the standard 8.5” x 11” format.

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Edit PDFs

Single-page PDFs are editable so you can make any necessary adjustments before printing and sending them to payers. You can use any PDF editor to make changes to the generated CMS-1500 PDF.

Note the following behavior and recommendations when printing CMS-1500 PDFs.

  • We recommend generating PDFs with a white background if you plan to print them on pre-printed claim forms.
  • The form boxes and labels must be printed in red ink and the item values must be printed in black ink for the claim form to be read by a scanner. Your vendor may choose not to process claim forms that don’t conform to these specifications.
  • Set the Page Size & Handling option to Actual size or the equivalent in your PDF reader application. The Fit option may cause the contents to be scaled down to fit within the printable area, causing the form fields to be misaligned when printed.
  • Don’t print forms from the Apple Preview app built in to macOS. There appear to be problems with field alignment and fonts. Instead, we recommend using either Adobe Acrobat or Google Chrome.

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Printer models

We generally recommend using business laser printers to print CMS-1500 claim form PDFs. However, due to mechanical variations between printer models, we can’t guarantee that the generated PDFs will align perfectly with pre-printed forms. You should always test the alignment with your printer before using the generated PDFs for official submissions.

You may not get acceptable results when using inkjet printer models because the file contents can extend beyond the normal printable area. If you do plan to use an inkjet printer, don’t enable a borderless option because this may cause the printer (or printer driver) to slightly magnify the page image regardless of other print settings. This behavior can crop form edges and cause form fields to appear in the wrong positions. Some inkjet printers have a manual setting to change the extension amount, but this isn’t always available and may not give consistent results.

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