Claim Format

The best method for sending claims is ANSI 5010 format. If you can not send in ANSI format please use the appropriate print image mapping for your claims.

ANSI 5010 Formats
Professional 5010 | 837-P Health Care Claim: Professional claim format.
Dental 5010 | 837-D Health Care Claim: Dental claim format.
Print Image Format
Professional ApexEDI Medical Print Image Mapping CMS-1500.
Dental ApexEDI Dental Print Image Mapping 2006 Form.