For providers whose Midlands Choice claim volume isn't sufficient for electronic submission to be feasible, we strongly encourage utilizing our online CMS-1500 claim form instead of paper. In addition to saving time and postage costs, using this online method helps ensure that you are submitting all the information necessary for automatic repricing of your claim. You may also use this form for submitting corrected claims.
Submit CMS-1500 Claims Online
Accessing the Claim Entry Form any other way than from the above link is not supported and may result in claims not being submitted. Please note that the Claim Entry Form is not supported when using Internet Explorer version 8 or older and may not function as expected.
NOTICE: By submitting a claim to Midlands Choice, you certify that the information in the claim is true, accurate and complete. You also certify that the claim complies with any instructions issued by the payer to which the claim will be submitted. Any person who knowingly files a statement of claim containing any misrepresentation or any false, incomplete or misleading information may be guilty of a criminal act punishable under law and may be subject to civil penalties.