Pluto EMR - Claim

Claim - CMS 1500 Style Layout

One-page claim workspace. Later, fields will auto-populate from the encounter, patient chart, and your provider profile, then generate a CMS-1500 / 837P file.

Patient Information

Patient Name

Date of Birth

Member ID

Address

Provider / Billing Information

Rendering Provider Name

NPI

Tax ID

Billing Address

Diagnosis (ICD-10)

CPT / HCPCS & Charges

From	To	Place	CPT/HCPCS	Mod	DX Ptr	Units	Charge

Totals

Total Charge

Amount Paid

Balance Due