Medical Claim Template

About this template

A medical claim is a formal request sent to health insurance providers to ask for coverage or compensation on a medical bill. If you’re a claims examiner for an insurance company, manage requests more easily with our free Medical Claim PDF Template. When insurance customers fill out your company’s online medical claim form, this template will automatically convert their information into polished PDFs that are easy to download, share, and print. Upgrade to an appropriate plan to better protect patient data with the help of our HIPAA-friendly features.

This Medical Claim PDF Template already has a professional design, but feel free to upload your logo for a more personalized form. Using our drag-and-drop PDF Editor, you can easily add more form fields or your company’s terms and conditions. Streamline your workflow by integrating your medical claim form with other apps you already use. You can instantly send submissions to your Google Drive account or Airtable spreadsheet to keep better track of requests, or connect the form to your Slack workspace to assign representatives to each case. By generating secure PDF medical claims for each request, your medical treatment claim form template will automate your company’s claim process, making it easier to help customers cover the costs of their healthcare.

Related templates

Doctors Note Template

Create a doctor’s note for your medical practice. Sign and send to your patients. Works on mobile, tablet, and desktop devices. Drag and drop to design.

Simple Medical History Template

Once you have collected these medical data, you can record them as a pdf by using this medical history PDF template. In addition, you don't need to be worried about the safety of data.

Pregnancy Verification Template

Verify the pregnancies of your clinic’s patients easily. Drag and drop to customize your form. Send out copies. Works on desktop, tablet, and mobile devices.

Client Progress Report

Client Progress Report for Psychotherapy PDF template provides the essential information that should contain in a clinical psychotherapy report such as the name of the patient, the type of session made with the patient, the date of the session, a comprehensive assessment, and treatment goals and objective for the patient/client.

Online Therapy Consent Template

Create an online therapy consent form to gather patient consent. Sign and fill out on any device. Drag and drop to fully customize. No coding knowledge required.

Release of Information Template

The Release of Information Template is a document that authorizes the disclosure of official or medical records to specific individuals or organizations

These templates are suggested forms only. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form.