Interactive HCFA-1500 Form – Box Guide with 837P Mapping

The HCFA-1500 (also known as the CMS-1500) is the standardized claim form used by healthcare providers to submit professional services for reimbursement. This form captures patient, provider, insurance, and claim details and is required by most payers for accurate processing.

Use our Interactive HCFA-1500 Form Tool to explore every section of the claim form. Simply click on any box (0–33) to see what information belongs there and how it maps to the X12 837P 5010 electronic claim format. Each box links directly to our detailed guides with examples, mapping notes, and compliance tips.

Tip: The form is fully keyboard-navigable and mobile-friendly. You can use the Tab key to jump between boxes or hover with your mouse to highlight specific fields. This makes it an excellent training and reference tool for providers, coders, and billers.

Eclaims – Interactive HCFA-1500 Form v1.0.0

Clickable, keyboard-accessible HCFA-1500 form with box-by-box overlays and direct links. Explore each field’s purpose and see precise X12 837P 5010 mappings with real code examples.

Questions
HCFA-1500 Claim Form Box 0 - Carrier Block Box 1 - Insurance Type Box 1a - Insured's ID Number Box 2 - Patient's Name Box 3 - Patient's Birth Date and Sex Box 4 - Insured's Name Box 5 - Patient's Address Box 6 - Patient Relationship to Insured Box 7 - Insured's Address Box 8 - Reserved For NUCC Use Box 9 - Other Insured's Name Box 9a - Other Insured's Policy or Group Box 9b - Reserved For NUCC Use Box 9c - Reserved For NUCC Use Box 9d - Insurance Plan Name or Program Name Box 10 - Is Patient's Condition Related To Box 10d - Claim Codes Box 11 - Insured's Policy Group or FECA Number Box 11a - Insured's Date of Birth and Sex Box 11b - Other Claim ID Box 11c - Insurance Plan Name or Program Name Box 11d - Is There Another Health Plan Box 12 - Patient's or Authorized Person's Signature Box 13 - Insured's or Authorized Person's Signature Box 14 - Date of Current Illness, Injury, Pregnancy (LMP) Box 15 - Other Date Box 16 - Dates Patient Unable to Work in Current Occupation Box 17 - Name of Referring Provider or Other Source Box 17a - Other ID Box 17b - NPI Box 18 - Hospitalization Dates Related to Current Services Box 19 - Additional Claim Information Box 20 - Outside Lab Charges Box 21 - Diagnosis or Nature of Illness or Injury Box 22 - Resubmission Code and Original Reference Number Box 23 - Prior Authorization Number Box 24a - Date(s) of Service Box 24b - Place of Service Box 24c - EMG Box 24d - Procedures, Services, or Supplies Box 24e - Diagnosis Pointer Box 24f - Charges Box 24g - Days or Units Box 24h - EPSDT/Family Plan Box 24i - Rendering Provider ID Qualifier Box 24j - Rendering Provider ID Box 25 - Federal Tax ID Number Box 26 - Patient's Account No. Box 27 - Accept Assignment Box 28 - Total Charge Box 29 - Amount Paid Box 30 - Rsvd for NUCC Use Box 31 - Signature of Physician or Supplier Including Degrees or Credentials Box 32 - Service Facility Location Information Box 32a - NPI Box 32b - Other ID Box 33 - Billing Provider Info & Phone No Box 33a - NPI Box 33b - Other ID

We hope you found this tool useful! Please reach out to us with questions/feedback.