fyllyoGovernment Forms
Form CMS-1500
Health Insurance Claim Form
Fyllyo uses local AI to interpret your documents, calculate required answers and fill PDF forms. Review the answers and their sources before saving, without uploading client documents.
A simpler way to prepare a PDF.
Pick a form
Choose a built-in template or set up your own blank fillable PDF once.
Add client documents
Drop in PDFs, scans, photos, Word files or typed notes. The AI reads them on your computer.
Review and save
Check the source lines, confirm key facts and edit the PDF. Uncertain values stay blank and flagged.
Form reference
Before you begin.
Use these notes as a starting point. Check the issuing agency’s current form and instructions for your client’s situation.
Open the source PDFFyllyo helps prepare PDFs. It doesn’t provide legal or tax advice, determine eligibility, or file forms for you.
Collect patient, insurance and service details
Have the patient's demographics and insurance card, the insured's details if different, any secondary coverage, the referring provider, diagnosis codes (ICD-10), procedure codes (CPT or HCPCS) with modifiers, dates of service, charges, and your NPI and tax ID.
Details worth checking
Insured and patient mixed up
Boxes 1 to 13 separate the patient from the insured. Swapping names, dates of birth or ID numbers is a common reason for denials.
Diagnosis pointers that don't match
Each service line in box 24E must point to the right diagnosis letter in box 21. A wrong pointer can make a service look not medically necessary.
Missing or wrong NPI
Billing and rendering provider NPIs belong in different boxes (33a and 24J). Leaving one out or putting it in the wrong place stops the claim.
Missing modifiers
Procedures that need a modifier, such as a distinct service or a bilateral procedure, are denied or underpaid without it.
Other coverage not disclosed
If the patient has other insurance, boxes 9 and 11d must say so, or coordination of benefits fails.
Printing and format
Payers that take paper claims expect the red-ink form and scan for machine-readable text. Keep entries inside the boxes and use the payer's date format.
Set up your own form once.
Fyllyo’s cloud service prepares a reusable template from your blank fillable PDF and setup instructions. No API key is required. Client documents stay on your computer, and subsequent filling runs locally. Check the first few filled forms carefully.
Mac with M1 or later · 16 GB memory recommended · About 8 GB free disk space