Claim form digitization

Convert CMS-1500 and UB-04 Claim Forms to JSON or Excel

Upload scanned or faxed CMS-1500 and UB-04 claims and get every box — patient, insured, diagnosis codes, service lines, NPI and charges — as structured data with a confidence score per field, so your team only checks what the reader is unsure about.

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All 33 boxes, not just totals

Patient, insured, ICD-10 codes, every service line, NPIs and signatures come out as named fields.

Confidence on every field

Low-confidence values are highlighted, so reviewers fix a handful of boxes instead of retyping the claim.

Built-in checks

NPI checksums and line totals are verified before the data reaches your billing system.

What an extracted CMS-1500 looks like

{
  "form": "CMS-1500",
  "box_1_insurance_type": "Group health plan",
  "box_1a_insured_id": "XHP448120931",
  "box_2_patient_name": "Example, Jane",
  "box_21_diagnosis": [
    {
      "code": "J06.9",
      "confidence": 0.98
    }
  ],
  "box_24_service_lines": [
    {
      "date_from": "2026-08-14",
      "place_of_service": "11",
      "cpt": "99214",
      "modifier": "",
      "diagnosis_pointer": "A",
      "charges": 210,
      "units": 1,
      "rendering_npi": "1234567893",
      "confidence": 0.95
    }
  ],
  "box_28_total_charge": 210,
  "box_33_billing_npi": "1234567893",
  "checks": {
    "npi_checksum_valid": true,
    "lines_add_up": true
  }
}

How to digitize a claim form

01
Scan the paper claim or export the fax as PDF.
02
Upload it to Formalini, one claim or a whole batch.
03
Review only the highlighted low-confidence boxes.
04
Export JSON, CSV or send it to your billing system by API or webhook.

Claim form questions

Does it read UB-04 institutional claims too?: Yes. UB-04 form locators, revenue codes and value codes are read the same way as CMS-1500 boxes.
Can it handle faxed, skewed or handwritten claims?: Yes. The reader handles skewed scans and handwriting, and marks uncertain values for review.
Can I send claims in bulk?: Yes. Upload a folder or use the API; results arrive by webhook.
Who designed the compliance workflow?: Marco Irinel Pascalini, a HIPAA-certified professional who has run HIPAA programmes for several companies. Files are encrypted, each workspace is isolated, clinical fields can be masked by role and every view is logged. The platform itself has no third-party certification; talk to us about a business associate agreement before uploading real patient data.