Free Forms and Resources
Sometimes you do not need software. You just need the form in front of you, or a look at the document nobody ever hands you to practice on. Two fillable forms and one worked sample. All three are free, all three are yours to use, and no email is required.
Superbill
A blank statement for insurance reimbursement. Fill it in on screen, print it, and hand it to your client so they can submit for reimbursement themselves. Built for cash practices and out of network providers who do not bill insurance directly.
Download the Fillable SuperbillCMS 1500 Claim Form
The standard claim form, still widely called the HCFA. Fillable on screen so you are not writing one out by hand. Use it when a payer wants a claim form rather than a statement, or when you need a clean copy for a client's records.
Open the Fillable CMS 1500Sample Remittance Advice
Two checks from two invented payers, laid out the way real ones arrive, with the arithmetic printed under every line. See what a remittance actually looks like before you have to post one. Three pages, nothing real, and four things worth checking before you post anything.
Download the Sample RemittanceHow your client uses the superbill
Fill out the form and give it to your client. Tell them to attach the prescription from their physician, the one carrying the diagnosis code. That prescription is what connects your service to a covered condition, and it is the piece clients most often leave out. If you have already been paid, enter the amount paid at the bottom so the reimbursement is directed correctly.
Submitting a superbill is never a guarantee of payment. Reimbursement depends entirely on the client's own plan.
Common questions
What is a superbill?
An itemized statement of the services you provided, given to your client so they can submit it to their insurance company for possible reimbursement. It is not a claim you file yourself.
Do I have to be in network to give a client a superbill?
No. Superbills are most often used by out of network and cash based practitioners, including massage therapists, counselors, and other providers who do not bill insurance directly.
What does my client need to submit with it?
Most insurers also want the prescription from the client's physician, because that document carries the diagnosis code connecting your service to a covered condition. Clients frequently leave this out, so tell them when you hand over the form.
What is the difference between a superbill and a CMS 1500?
A superbill is a statement you give your client to submit themselves. A CMS 1500 is the standard claim form used to bill a payer directly. Which one you need depends on the payer and on whether you are billing on the client's behalf.
Is the HCFA the same as the CMS 1500?
Yes. HCFA is the older name and many practitioners still use it. The current form is the CMS 1500.
Do I need billing software to use these forms?
No. Both are fillable PDFs. Complete them on screen, save them, and print them without any billing system.
What does a remittance advice actually look like?
Download the sample above and you will see one. A remittance tells you seven things: who paid, for whom, for what, how much was billed, how much was allowed, what came off and why, and what is left. Every payer lays those seven things out differently, which is what makes them hard to read at first.
What is the difference between an EOB and an ERA?
An explanation of benefits is the written version, and an electronic remittance advice is the electronic file carrying the same information straight into your system. Same information, different delivery. Most practices set up electronic remittance with their payers so the documents arrive without waiting on mail or logging into a separate portal.
Why does the sample say everything in it is invented?
Because it is. Every plan, practice, person, identifier, date and dollar amount in that document was built from scratch. A real remittance carries patient information that cannot be safely shared, so the only responsible way to teach from one is to build a clean one.
Will my client definitely be reimbursed?
No. Submitting a superbill is never a guarantee of payment. Reimbursement depends entirely on the client's own plan, their deductible, and whether their policy covers out of network care.
Written by Marie Matteson, MS, healthcare consultant and Office Ally specialist with more than 30 years in healthcare, emergency medicine, and practice management. Using Office Ally since 1999 and not affiliated with the company.
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The forms above are provided as blank templates for practitioner convenience. The sample remittance advice is teaching material and every payer, person, identifier, date and amount in it is invented. Payer behaviour shown is an example, not a payer rule. Marie Matteson does not work for Office Ally and is not affiliated with, sponsored by, or endorsed by Office Ally. This content is educational and is not billing, legal, tax, or coding advice. Always follow your payer contracts, your practice policies, and current coding guidelines.