The Centers for Medicare and Medicaid Services (CMS) 1500 claim form is the acceptable standard for paper billing of professional medical services. To fill out the application form, first, download and print it from our website.I declare that to the best of my knowledge, the residency, financial, and insurance information provided in this form is true, correct and complete. Documents in civil case types can be submitted via eFiling through an electronic filing service provider (EFSP). Read claim thoroughly. 2. Call the Injury Intake Center at (888) 826-7835 and complete the New Injury Packet (Fillable) and submit a copy to Workers' Compensation Division. To submit your claim via these measures, please complete a Claim for Damages form (PDF) and return it to us along with all supporting documentation. Your physician needs to complete the form and include the necessary documentation required in the form. You may be asked to complete a form, submit a formal letter, or otherwise verify how your financial aid eligibility has changed. , if a Medicare claim is being filed, check the.