CMS-1500 filing software for dental insurance specialists.
Stampwright automates the CMS-1500 form end-to-end — patient intake PDF and procedure notes (CSV/Excel) in, every Box 1–33 cited, every field cross-checked against ADA, Medicare, and NUCC, file-ready packet out. Stop chasing payer rejections on misfilled fields.
Same-business-day reply with pilot scope and a quote.
Document ingestion. Citation-backed fill. Cross-checked submission.
Three steps that turn the CMS-1500 from the form a specialist rebukes into a packet a specialist signs. Every figure pinned to a source line. Every Box checked against the live rule set.
- Step 01
Document ingestion
Drop the patient intake PDF and procedure notes (CSV or Excel); Stampwright OCRs, classifies, and pins every figure to a citation.
- Step 02
Citation-backed field fill
Every CMS-1500 box 1–33 populated from a source line, with the citation on hover. Reviewers see a draft, not a guess.
- Step 03
Cross-checked submission
Live ADA / Medicare / NUCC rule mirror; pass / warn / fail per field; file-ready packet your specialist signs without redoing the middle.
See it work on one CMS-1500 dental claim.
Two synthetic source documents → every Box 1–33 cited → live ADA / Medicare / NUCC cross-check. HIPAA-safe synthetic Jane Q. Sample. Synthetic data only on the demo; the rule mirror is live.
The CMS-1500 dental claim, end-to-end.
Two intake documents feed every Box 1—33. Each value carries an inline source citation. Edits re-run the cross-check against the latest ADA & Medicare rule set; the report flags pass / warn / fail in real time.
Source documents that drove every field
Two docs. Every field.
The intake document identifies the patient and the insurance program; the procedure notes identify the services, charges, and providers. Each highlighted span is cited by at least one CMS-1500 box.
- · Highlighted spans in each source line.
- · Hover a span to see the Box it was extracted into.
- · Click a Box number to jump to the form.
Take the demo deeper.
Try it on your own files.
Drag a patient intake PDF and procedure notes into the drop zone; CMS-1500 boxes populate with inline source citations.
The full filing package, side-by-side.
Every Box 1–33 populated from the intake + procedure documents, with the per-field ADA / Medicare / NUCC cross-check report.
Three tiers, one rule mirror.
Solo $200/mo, Team $500/mo, Multi-seat $2,000/mo — same source-cited extraction and cross-check on every plan.
Bring one CMS-1500 form — we'll automate it before your next deadline.
We onboard dental-insurance specialists one at a time, with a clear success criterion: a file-ready packet your specialist signs without redoing the middle. Drop your email and we will be in touch.
Same-business-day reply with pilot scope and a quote.
Every Box, 1–33, with its own field guide.
The thirty-three numbered boxes on the CMS-1500 (02/12) form, each on its own page — the official field, what goes there, the common mistakes that bounce claims, and the matching cross-check rule on /rules.
- Box 1Program / payer type checkboxes
- Box 2Patient's name
- Box 3Patient's date of birth and sex
- Box 4Insured's name
- Box 5Patient's address and telephone
- Box 6Patient relationship to insured
- Box 7Insured's address
- Box 8Reserved for NUCC use
- Box 9Other insured (when secondary coverage exists)
- Box 10Condition related to employment, auto, other accident, claim codes (10a–10d)
- Box 11Insured's policy / group number (with 11a–11d plan block)
- Box 12Patient signature (intake authorization)
- Box 13Patient / authorized person signature (assignment of benefits)
- Box 14Date of current illness, injury, or pregnancy (LMP)
- Box 15Other date (qualifies Box 14)
- Box 16Dates patient unable to work / current injury dates
- Box 17Referring / ordering provider (with 17a NPI and 17b taxonomy)
- Box 18Hospitalization dates related to current services
- Box 19Additional claim information
- Box 20Outside lab / diagnostic service provider
- Box 21Diagnosis or nature of illness (ICD-10-CM)
- Box 22Prior authorization / referral number (resurfaced)
- Box 23Prior authorization number
- Box 24Service line rows (24A–24J)
- Box 25Federal tax ID (EIN)
- Box 26Patient's account number (practice-assigned)
- Box 27Accept assignment?
- Box 28Total charge
- Box 29Amount paid
- Box 30Balance due
- Box 31Provider signature on file
- Box 32Service facility location
- Box 33Billing provider info (33 with 33a / 33b)