Graftek Communications   

Specializing in the PERSONALIZING OF CMS 1500 / HCFA 1500 Claim Forms!

CMS 1500 claim forms

Here's a sample of how completely we can personalize your New Version 02/12 CMS 1500 claim forms. We can also personalize the older 08/05 version.

Plus some providers creates separate personalized forms for different insurance carriers.


FREE SAMPLE of your personalized claim forms BEFORE you order!

There's no risk when you order from Graftek because we'll provide you a sample proof of what your claim form will look like before you commit to ordering! If you don't like the sample, you can say you don't want to proceed - at no cost or obligation. You can also change it as often as you like before we print at no additional charge. We don't print until you're completely satisfied with your claim form.

Custom imprinted claim forms SAVE YOU CLERICAL TIME!

Your office staff isn't using valuable time filling our repetitive information on your claim. Instead they can be following up collections or booking patients instead of writing your practice name in box 33 each time they file a claim.

Custom prefilled claim forms SPEED UP PAYMENT by REDUCING REJECTED  CLAIMS!

Customer using personalized claim forms reduce denials due to clerical errors - such as illegible numbers or poorly stamped addresses. Any preprinted information can't be a cause for rejection by the carrier.

You will speak to a real person who is an expert about 1500 claim forms when you call Graftek!

We personally take your order and know from years of experience what works or what will be a problem on your claim forms. We've been personalizing claim forms for over 20 years. You can order with confidence knowing we will not knowingly let you make a mistake. (PS - If we don't answer when you call it just means we're on the line with someone else. You can leave a message and we'll call you back or you can call again).

We will imprint AS MUCH INFORMATION on your form as you want - at an all inclusive low price!

We're different from other claim form providers in that we will print your signature, procedure codes - ANYTHING ANYWHERE - on your form at an all inclusive low price. The only additional charge is shipping (and sales tax if you are in Florida).

Frequently asked questions about CMS1500 personalization:
1. Do I need the 4 digit Zip Code + 4 extension on my form?
Yes. Medicare is requiring it and although your Medicare intermediary (claims processor) might not have rejected the claim for lack of the Zip+4 extension, at some time they will enforce this requirement. You can find the Zip+4 extension for your address on any non-stamped mail addressed to the office you will list in Box 33.
2. Can I preprint my NPI and codes in all 6 lines in Box 24?
Some Medicare intermediaries will reject  claims that have an NPI number printed in all 6 lines when they are missing dates of service. They will assume a filing error. We suggest you can put your NPI number in as many rows as you know you will always complete on a claim. You know you will have your NPI in at least the first line of Box 24 so that can be preprinted.
3. Will my claim be rejected if I print my signature?
In our 25 years of customizing forms we've never had anyone come back to us saying their claim was rejected because of a printed signature.
4. What boxes do most customers normally preprint?
Generally "NO" in Box 10 - A, B and C; "Signature on file" in Boxes 12 and 13; Tax ID in Box 25, Box 27 "YES" for assignment; signature in Box 31; Name and Address in 32 and 33; NPI in Box 33A.
5. How long does it take to get personalized forms?
After you approve the proof we supply you, your forms are generally printed in 5-7 business days. Plus you need to allow anywhere between 2-5 business days for shipping - depending where you are located.

Click HERE is you want to see a sample of the new CMS 1500 form with changes highlighted!

Have a question about imprinted CMS forms? Email me - - anytime or any day - and I'll reply by email within 1 hour.

Same prices for CMS 1500 version 08/05 or the new version 02/12!

1 part personalized 1500 claim forms (original)

Price includes all setup and proofs but excludes shipping and sales tax for Florida customers. Printed on high quality white bond. Prices are same for old 08/05 and new 02/12 version.

500 - $55
1000 - $83
2000 - $139

2 part personalized carbonless 1500 claim forms (original and 1 copy)

Price includes all setup and proofs but excludes shipping and sales tax for Florida customers. Printed on heavyweight carbonless (no carbon) paper. Top original is white and copy underneath is yellow. Prices are the same for old 08/05 and new 02/12 version.

250 - $73
500 - $103
1000 - $171

Click HERE to download a New Version CMS 1500 02/12 to complete to submit for personalization.

Ordering is SIMPLE!  You can either:

1. Call us at 800-848-2992 Monday through Friday 9 AM to 6 PM Eastern Standard Time. We'll take your imprint information down over the phone. - or -

2. Fax us a hand written sample to 800-235-7954. Please include your phone number and we'll call you back - or -

3. Email us a sample or the imprint information to  - or -

4. Go to our online store Fax a sample to 800-235-7954, take a cellphone picture and email it to us at, or go to the "Contact Us" form in the store and send the imprint information in the message portion of the box - or -

About Graftek Communications
For over 25 years Graftek has been supplying personalized CMS 1500 claim forms to providers throughout the US. NO ONE personalizes more information on claim forms than Graftek.

Graftek Communications
- your Medical and Legal Forms Professionals
PO Box 27-6228 - Boca Raton FL 33427  Tel: 800-848-2992  Fax: 800-235-7954
Copyright 2015 Graftek Communications All rights reserved.