HIPAASOC2
Process CMS-1500 Claim Form Extractor — HIPAA Compliant
Healthcare organizations process thousands of documents daily. Manual processing delays patient care and increases compliance risk.
137
Fields Extracted
240s
Max Processing
Common Pain Points
- HIPAA violations cost $50K-$1.5M per incident
- Manual processing delays patient care
- Paper-based workflows increase error rates
- Audit preparation takes weeks without structured data
What This Template Does
AI-powered extraction using gemini-2.5-flash. Part of 113 production-ready templates.
Capabilities
- Healthcare Extraction
- Claims Processing
- Cms 1500 Extraction
- Claims
- Cms 1500
Output Schema
{
"$schema": "http://json-schema.org/draft-07/schema#",
"title": "CMS-1500 Claim Form Extraction",
"description": "Schema for extracted data from CMS-1500 (HCFA-1500) professional claim forms",
"type": "object",
"required": [
"document_type",
"patient_info",
"diagnosis_codes",
"service_lines",
"billing_provider"
],
"properties": {
"document_type": {
"type": "string",
"const": "cms_1500",
"description": "Document type identifier"
},
...Quick Start
$ pip install doclayer
$ doclayer process document.pdf --agent healthcare.cms-1500
See It In Action
Real extraction example showing input document and structured output.
Input Document
HEALTH INSURANCE CLAIM FORM
APPROVED BY NATIONAL UNIFORM CLAIM COMMITTEE (NUCC) 02/12
PAYER:
BLUE CROSS BLUE SHIELD OF ILLINOIS
P.O. BOX 805107
CHICAGO, IL 60680-4112
PAYER ID: 00621
================================================================================
PATIENT AND INSURED INFORMATION
================================================================================
1. MEDICARE MEDICAID TRICARE CHAMPVA GROUP FECA OTHER
[ ] [ ] Extracted Data
{
"document_type": "cms_1500",
"form_version": "02/12",
"carrier_info": {
"box_1": "Group Health Plan",
"payer_name": "BLUE CROSS BLUE SHIELD OF ILLINOIS",
"payer_address": "P.O. BOX 805107, CHICAGO, IL 60680-4112",
"payer_id": "00621"
},
"insured_info": {
"box_1a_id": "XYZ789456123",
"box_4_name": "JOHNSON, MICHAEL R",
"box_7_address": {
"street": "1842 MAPLE AVENUE",
"city": "SPRINGFIELD",
"state": "IL",
"zip": "62701",
"phone": "(217) 555-0142"
},
"box_11_group": "GRP-445521",
"box_11a_dob": "1975-03-15",
"box_11a_sex": "M",
"box_11b_other_claim_id": "",
"box_11c_plan_name": "BCBS PPO PREMIER",
"box_11d_other_insurance": "No"
},
"patient_info": {
"box_2_name": "JOHNSON, MICHAEL R",
"box_3_dob": "1975-03-15",
"box_3_sex": "M",
"box_5_address": {
"street": "1842 MAPLE AVENUE",
"city": "SPRINGFIELD",
"state": "IL",
"zip": "62701",
"phone": "(217) 555-0142"
},
"box_6_relationship": "Self",
"box_8_reserved": "",
"box_10a_employment_related": "No",
"box_10b_auto_accident": "No",
"box_10b_state": "",
"box_10c_other_accident": "No"
},
"other_insurance": {
"box_9_other_insured_name": "",
"box_9a_other_policy": "",
"box_9b_reserved": "",
"box_9c_reserved": "",
"box_9d_other_plan": ""
},
"condition_info": {
"box_10d_claim_codes": "",
"box_14_date_of_illness": "2024-12-05",
"box_14_qualifier": "431",
"box_15_other_date": "",
"box_15_qualifier": "",
"box_16_dates_unable_work": {
"from": "",
"to": ""
},
"box_18_hospitalization_dates": {
"from": "",
"to": ""
}
},
"referring_provider": {
"box_17_name": "CHEN, DAVID L MD",
"box_17_qualifier": "DN",
"box_17a_other_id": "",
"box_17b_npi": "1234567890"
},
"diagnosis_codes": {
"box_21_icd_indicator": "0",
"diagnosis_a": "J06.9",
"diagnosis_b": "R05.9",
"diagnosis_c": "R50.9",
"diagnosis_d": "",
"diagnosis_e": "",
"diagnosis_f": "",
"diagnosis_g": "",
"diagnosis_h": "",
"diagnosis_i": "",
"diagnosis_j": "",
"diagnosis_k": "",
"diagnosis_l": ""
},
"service_lines": [
{
"line_number": 1,
"box_24a_dos": {
"from": "2024-12-10",
"to": "2024-12-10"
},
"box_24b_pos": "11",
"box_24c_emg": "",
"box_24d_cpt_hcpcs": "99214",
"box_24d_modifiers": [
"25"
],
"box_24e_diagnosis_pointer": "AB",
"box_24f_charges": "185.00",
"box_24g_units": "1",
"box_24h_epsdt": "",
"box_24i_id_qualifier": "",
"box_24j_rendering_npi": "1987654321",
"box_24j_other_id": ""
},
{
"line_number": 2,
"box_24a_dos": {
"from": "2024-12-10",
"to": "2024-12-10"
},
"box_24b_pos": "11",
"box_24c_emg": "",
"box_24d_cpt_hcpcs": "87880",
"box_24d_modifiers": [],
"box_24e_diagnosis_pointer": "A",
"box_24f_charges": "45.00",
"box_24g_units": "1",
"box_24h_epsdt": "",
"box_24i_id_qualifier": "",
"box_24j_rendering_npi": "1987654321",
"box_24j_other_id": ""
},
{
"line_number": 3,
"box_24a_dos": {
"from": "2024-12-10",
"to": "2024-12-10"
},
"box_24b_pos": "11",
"box_24c_emg": "",
"box_24d_cpt_hcpcs": "94760",
"box_24d_modifiers": [],
"box_24e_diagnosis_pointer": "A",
"box_24f_charges": "35.00",
"box_24g_units": "1",
"box_24h_epsdt": "",
"box_24i_id_qualifier": "",
"box_24j_rendering_npi": "1987654321",
"box_24j_other_id": ""
}
],
"billing_info": {
"box_25_federal_tax_id": "36-XXXXXXX",
"box_25_ssn_ein": "EIN",
"box_26_patient_account": "PAT-2024-001542",
"box_27_accept_assignment": "Yes",
"box_28_total_charge": "265.00",
"box_29_amount_paid": "0.00",
"box_30_reserved": "",
"box_31_signature": "Dr. Sarah M. Patterson, MD / 12/10/2024"
},
"facility_info": {
"box_32_service_facility": {
"name": "SPRINGFIELD FAMILY MEDICINE CLINIC",
"address": "500 MEDICAL CENTER DRIVE, SUITE 200, SPRINGFIELD, IL 62702",
"npi": "1122334455",
"other_id": ""
}
},
"billing_provider": {
"box_33_name": "SPRINGFIELD FAMILY MEDICINE CLINIC",
"box_33_address": {
"street": "500 MEDICAL CENTER DRIVE, SUITE 200",
"city": "SPRINGFIELD",
"state": "IL",
"zip": "62702",
"phone": "(217) 555-0300"
},
"box_33a_npi": "1122334455",
"box_33b_other_id": ""
},
"prior_authorization": {
"box_23_prior_auth": ""
},
"additional_claim_info": {
"box_19_additional_info": "",
"box_20_outside_lab": "No",
"box_20_charges": "",
"box_22_resubmission": {
"code": "",
"original_ref": ""
}
},
"calculated_fields": {
"total_line_charges": "265.00",
"line_count": 3,
"diagnosis_count": 3
},
"validation": {
"required_fields_present": true,
"npi_format_valid": true,
"icd_codes_valid": true,
"cpt_codes_valid": true,
"pos_codes_valid": true,
"charges_match_total": true,
"dates_logical": true
}
}Example of a CMS-1500 claim for a routine office visit with basic diagnostic procedures. Demonstrates extraction from a standard group health plan claim with multiple procedure codes and normal billing scenario.
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Frequently Asked Questions
What documents can CMS-1500 Claim Form Extractor process?
The CMS-1500 Claim Form Extractor template processes healthcare documents including various formats and layouts. See the instructions for specific document types supported.
How accurate is the CMS-1500 Claim Form Extractor extraction?
The CMS-1500 Claim Form Extractor template uses Gemini 2.5 Flash for high-accuracy extraction. Results include confidence scores for each field.
Can I customize the CMS-1500 Claim Form Extractor template?
Yes, you can modify the extraction schema, add custom fields, or adjust the instructions to match your specific requirements.
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