CMS-1500 Simple wizard

Three-step guided form to send a clean Medicaid or Medicare claim.

4 stepsUpdated for AveeCare
In this guide
Open the CMS-1500 wizard from a visit rowSelect: pick patient, visits, and pass Readiness CheckClinical: add diagnosis codes and confirm service linesReview: confirm and submit the claim

The CMS-1500 Simple wizard is AveeCare's three-step guided form for sending a professional (837P) claim to a payer. It opens on the Billing page from the per-row shield icon, defaults to the Simple tab, and walks Select then Clinical then Review. The wizard auto-fills as much CMS-1500 data as it can from the patient, visit, and company records, and gates progress with a Readiness Check so you cannot submit a claim that's missing a required segment.

Quick answer

Open Billing, scroll the Visit Billing table right, and click the small blue shield icon on a row whose patient has insurance on file. The CMS-1500 Professional Claim (837P) modal opens on the Simple tab at step 1, Select. Pick the patient, tick the visits to bill, clear any Readiness Check warnings, then step through Clinical (diagnosis codes + service lines) and Review. Click Generate X12 to download the 837P file or Submit to Clearinghouse to send it directly.

Open Billing

Simple vs Advanced

The CMS-1500 modal opens on the Simple tab by default. Simple is the three-step guided wizard most home care agencies use day-to-day. The Advanced tab next to it exposes the full 30+ CMS-1500 box surface for billers who need to override individual fields. You can switch between tabs at any time; the wizard and the advanced form share the same underlying claim state.

1. Open the CMS-1500 wizard from a visit row

  1. Click Billing in the left nav, then scroll the table right.

    The shield icon lives in the Actions column at the far right of Visit Billing. On a 1080p screen you may need to scroll the table horizontally to expose it.

  2. Click the small blue shield icon on a row whose patient has insurance.

    The hover tooltip reads Generate insurance claim (837P). Rows without an insurance record on the patient do not show this icon. The CMS-1500 Professional Claim (837P) modal opens on the Simple tab.
    CMS-1500 Professional Claim (837P) modal open on the Simple tab, step 1 Select, with the Simple tab called out in a red box. Patient is Beto, Betsy. The Visits list shows seven Standard Care visits. The Readiness Check below lists Patient Demographics passed, Billing Provider with 5 missing, Rendering: Barbara Walters with 1 missing, Insurance Info with 1 missing, and Service Facility passed.

2. Select: pick patient, visits, and pass Readiness Check

  1. Confirm or change the patient at the top of the modal.

    If you opened the wizard from a row, the patient is preselected from that visit. You can switch patients from the Patient dropdown without closing the modal.

  2. Tick the visits to include on this claim.

    The Visits list shows every billable visit for the selected patient. Use individual row checkboxes for a targeted claim, or tap Select All at the top right to bill the whole list. You can also click Add another visit to add a manual service line that isn't tied to a real visit.

  3. Clear the Readiness Check warnings before clicking Next.

    The Readiness Check at the bottom audits five CMS-1500 segments against the patient, company, caregiver, and visit records: Patient Demographics, Billing Provider, Rendering Provider (one entry per assigned caregiver), Insurance Info, and Service Facility. A row marked N missing is expandable. Click into it, fill the missing field, save, and the row turns green. Next stays disabled until every row passes.

3. Clinical: add diagnosis codes and confirm service lines

  1. Search Diagnosis Codes (ICD-10) at the top of the Clinical step.

    Type two or more characters into the ICD-10 search to filter home health relevant codes; click an entry to add it. The wizard supports up to 12 codes (pointers A through L). If you have claim presets configured for this service type, a Suggested Diagnoses row appears above the search and lets you one-click any preset diagnosis onto the claim.
    CMS-1500 Simple wizard on the Clinical step with the Diagnosis Codes (ICD-10) search field called out in a red box. Service Lines below show three lines per selected visit (Nicholas Johnzon, Barbara Walters, Barbara Walters) with Date From, Date To, HCPCS/CPT, Modifiers, Place of Svc, Charges, Units, Dx Pointer, and Rendering NPI fields.

  2. Confirm the auto-built Service Lines, one per ticked visit.

    Each selected visit gets a service line with date, HCPCS/CPT code, modifiers, place of service (12 = home by default), charges, units, diagnosis pointer, and the rendering caregiver's NPI. Most fields are prefilled from the visit or the matching claim preset. Adjust as needed. Manually added lines start blank and need every field filled in.

  3. Optional: expand Add prior authorization # to attach an auth.

    If the payer required prior auth for these visits, click + Add prior authorization # below the service lines and enter the auth number. It maps to CMS-1500 box 23.

4. Review: confirm and submit the claim

  1. Read the Claim Summary and Provider Summary cards at the top.

    The Review step lays out the final 837P in plain language: Patient, DOB, Insurance Type (Medicare, Medicaid, Other), Insurance ID, Payer Name, Group #, and Subscriber on the left; Billing Provider, Billing NPI, Tax ID, and Rendering Provider on the right. Click Edit on either card to jump back to the right step and fix something.
    CMS-1500 Simple wizard on the Review step with the Claim Summary card called out in a red box. The step indicator shows Select and Clinical checked green and Review highlighted blue. Claim Summary lists Patient Beto, Betsy, DOB 1944-01-08, Insurance Type Medicare, Insurance ID, Payer Name Evergreen Health Assurance, and Group #. Provider Summary lists Billing Provider Example Company, Billing NPI 1234567890, Tax ID, and Rendering Provider Johnzon, Nicholas.

  2. Scroll the Service Lines table to spot-check codes and charges.

    The full table of service lines (one row per visit) renders below the summary cards, with a Total at the bottom. This is your last chance to spot an obviously wrong charge or modifier before the file leaves AveeCare.

  3. Click Generate X12 to download the 837P, or Submit to Clearinghouse to send it.

    Generate X12 packages the claim into an ANSI X12 5010 837P file and downloads it locally. Upload that file to your clearinghouse portal (Availity, Trizetto, Office Ally, Optum, Waystar). Submit to Clearinghouse requires an active clearinghouse connection in Settings and ships the file straight from AveeCare. After submission, the claim's Status badge on the Visit Billing table moves through Submitted, Acknowledged, and finally Paid (or Rejected / Denied).
    CMS-1500 Simple wizard Review step scrolled to the bottom, with the Submit to Clearinghouse and Generate X12 action buttons called out in a red box. Back button on the left, Total $0.00 above the action row.

Common pitfalls

  • Next is disabled on Select. The Readiness Check is gating you. Expand every yellow N missing row, fill the missing fields inline, save, and the row turns green. Once all rows are green, Next activates.
  • No shield icon on the row. The Generate insurance claim button only shows up for visits whose patient has insurance on file. Add an insurance record on the patient's Insurance tab and the icon will appear on subsequent visits.
  • Diagnosis codes blocked at 12. CMS-1500 box 21 supports pointers A through L, so the wizard caps you at 12 diagnosis codes. If you need to add a 13th, remove one of the existing entries first.
  • Wrong place of service. The wizard defaults Place of Svc to 12 (home). If you billed a visit at an assisted living facility, the patient's home, a hospital discharge bridge visit, or anywhere else, change the POS code on the service line before Review.
  • Submit to Clearinghouse fails with no connection. This button only works after you have configured a clearinghouse connection in Settings. Without one, use Generate X12 to download the file and upload it to your clearinghouse portal by hand instead.
  • Switching to Advanced loses nothing. The Simple wizard and the Advanced form share the same claim state, so flipping tabs mid-claim is safe. Use Advanced when you need to override a CMS-1500 box that the wizard doesn't expose.

Frequently asked questions

Use Simple for the vast majority of home care 837P claims. It auto-fills CMS-1500 fields from the patient, visit, and company, runs a Readiness Check before letting you submit, and keeps the surface tight. Switch to Advanced when you need to override an individual CMS-1500 box (box 17 referring provider, box 32 service facility override, box 11d another plan, and so on) that the wizard does not expose.
The Readiness Check at the bottom of step 1 is failing. Expand every row marked N missing, fill the missing fields inline, click Save, and the row will turn green. Next activates once every row passes. Common offenders are a missing company NPI, a missing caregiver NPI, or a missing patient address.
Procedure codes come from each visit's service code (or from a matching claim preset if you have one configured for the service type). Diagnosis codes are not auto-applied, but if a matching claim preset exists for the resolved service type (Skilled Nursing, Physical Therapy, Home Health Aide, Hospice, Standard Care), the wizard shows its diagnosis codes as one-click suggestion chips above the ICD-10 search.
There is no hard cap in the wizard. Tick as many visit rows in Select as you want and each becomes a service line on the claim. CMS-1500 has a six-line print form, but the 837P EDI envelope supports many more. Practical advice: keep one billing month per claim so payer responses are easier to match.
Five CMS-1500 segments: Patient Demographics (name, DOB, gender, address, city, state, zip), Billing Provider (company NPI, Tax ID, taxonomy, business address), Rendering Provider (one row per assigned caregiver, gated on caregiver NPI), Insurance Info (payer ID, member ID, payer name on the patient record), and Service Facility (facility name, address, NPI on the company record). If any required field on any segment is blank, that segment shows N missing and blocks Next.
The wizard does not save partial work as a separate draft record. If you close the modal mid-claim, the next time you open the wizard for the same patient it will rebuild the Readiness Check fresh against current data. You can leave the modal open across browser tabs while you fix referenced data (a caregiver NPI on Caregivers, a payer ID on the patient Insurance tab) and then return to the wizard.
The claim's Status badge on the Visit Billing table moves to Submitted, then Acknowledged once the clearinghouse accepts the 277CA / 999, and finally Paid (or Rejected / Denied) when the payer responds. Clicking a Rejected or Denied badge opens the rejection detail modal with the outbound 837 file, the inbound clearinghouse response, and the payer's denial codes so you can fix and resubmit.
Written by
Calvin Nesvig
Founding Partner, AveeCare

Builds AveeCare full-time. The AveeCare Help Center is written and maintained by the team that builds the product, so the steps in every article come from the same people who ship the features.

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