Little Guy Software®

Big Guy Software Designed for the Little Guy

ORDERING FORM- for CURRENT CMS 1500 Software and Forms, UB 04 Software

and our Practice Enchancement Software

Yes, the most recent CMS 1500 form update was implemented in January, 2014 and is called version 02/12 !

All of our Software and Forms are updated for full ICD-10 compatibility

** Special Offer - Discounts **

** Purchase the CMS 1500 Form Filler "Bundle" or "Bundle Plus" of CMS 1500 software and forms at regular price (unchanged from last year) and get the Insurance Tracker at $40. OFF.    Or get our Family Health Care Tracker  currently on sale at $39.50.

Please Read - This ordering form uses Javascript to do calculations automatically.  If you do not have javascript enabled in your web browser, you will need to do the calculations manually, after you complete and print out the form.   You can print the form using 'file' 'print'.  Enter the quantities, shipping costs and totals manually, if they have not calculated and printed automatically.

Please tell us who you are (red denotes required information): NO HANDWRITTEN ORDERS. PLEASE TYPE ALL INFO

SHIP TO ADDRESS:

Name  
Address  
be specific about suite or apartment nos.
City   State Zip Code
Company Name  
Email  
Phone   Other Contact Info:
Returning Customers   I am a Returning Customer     your Customer ID no. please (on your disk or CD)

 ** Note that all CMS software and forms on this order form are for the current CMS (HCFA) 1500 called version 02/12,  implemented in January, 2014.  It is the correct form for ICD-10 billing.

   All Software and Forms are updated for ICD-10 compatibility  and work with Windows XP, Vista, 7, 8 and 10.   Macs, too.

EASYCMS 1500 SOFTWARE   for  Windows

For use with the  UPDATED   CMS 1500 Form

Quantity Price

subTotal

EASYCMS 1500 Form Filler Software© -  for the CMS 1500 form.  For billing with ICD-10
For individual clinicians only. (Companies/Groups/Organizations - see the Group Version Below) Customized Free. Delivered As A Download.

 

65.00

EASYCMS 1500 Form Filler©  "Bundle"  -Customized  Software on CD and  500 CMS 1500 Forms. Individual Version only. For billing with ICD-10     A Value Bundle. Delivered As A Download. Free Shipping of forms.

**Purchase this Bundle and get the Insurance Tracker or Family Health Care Tracker at $40.00 off  their regular price.

 

89.50
EASYCMS 1500 "Bundle Plus" © - Software, Consultation, Training, Free Phone Support and 500 FREE CMS 1500 claim forms.  For billing with ICD-10.   Individual Version.  Customized Free. A Value Bundle. Delivered As A Download. Free Shipping of forms. This includes training on the changes to the new CMS 1500 form.

**Purchase this Bundle and get the Insurance Tracker or Family Health Care Tracker at $40.00 off  their regular price

 
124.50
EASYCMS 1500 Form Filler  Software© - GROUP VERSION  for the CMS 1500 form.  For billing with ICD-10.   Customized Free. Delivered As A Download.

 

98.50

EASYCMS 1500 SOFTWARE   for the Mac

For the UPDATED   CMS 1500 Form

 Quantity
Price

subTotal

EASYCMS 1500 Form Filler Software© -  for the CMS 1500 form. For billing with ICD-10. For individual clinicians only.  (Companies/Groups/Organizations - see the Group Version Below) Customized Free - See Below. For use on a Mac (must have Microsoft Word)

Delivered As A Download.

81.00

EASYCMS 1500 Form Filler©  "Bundle"  -Customized  Software on CD and  500 CMS 1500 Forms .  For billing with ICD-10. A Value Bundle- Delivered As A Download and Free shipping of forms. For the Mac (must have Microsoft Word)

 
105.50
EASYCMS 1500 "Bundle Plus" © - Software, Consultation, Training, Toll-Free Support and 500 FREE claim forms.  Individual Version.  For 2015 billing with ICD-10.   Customized Free - See Below. For the Mac (must have Microsoft Word)   A Value Bundle- Delivered As A Download and Free shipping of forms.   This includes training on the changes to the new CMS 1500 form.

 
138.50
EASYCMS 1500 Form Filler  Software© - GROUP VERSION  for the CMS 1500 form.   For billing with ICD-10,   Customized Free.  For group practices and organizations. For the Mac (must have Microsoft Word) Delivered As A Download.

 
114.50

UB 04 and HCFA 485 SOFTWARE (for Windows and Macs)

 Quantity
Price

subTotal
UB 04 -2015 ICD-10 Form Filler for the UB 04. Delivered As A Download.
109.00
EASY HCFA 485  Software for the HCFA/CMS   485/486/487. Delivered As A Download.
55.00

PRACTICE ENHANCEMENT SOFTWARE for Windows and Macs that are also running Windows

(for all health care -Psychology, Psychiatry, Social Work, OT, PT, Etc.)

Quantity
Price

subTotal
Insurance Tracker Software - Single Clinician Version - for Windows    Version 5

Track health insurance authorizations and payments.  Stay alert to remaining sessions authorized and required reports.  Makes managed care easier (nothing makes it easy).  Generate patient bills.  You've never been this organized.  For Individual Clinicians. only  $89. Delivered as an easy to install download.

* Take $40.00 off the price of this software if purchased with the CMS 1500 "Bundle" or "Bundle Plus", (calculations at bottom of order form)

89.00
Insurance Tracker Software - Group Version 4.3- for Windows

Unlimited Clinicians in one practice. Track health insurance authorizations and payments.  Stay alert to remaining sessions authorized and required reports. One click reports for each clinician or group practice. Create custom patient bills in just a few clicks. It's never been this easy. Network Capable.   $149. Delivered As A Download.
* Take $40.00 off the price of this software if purchased with the Updated CMS 1500 "Bundle" or "Bundle Plus", or Group Version (calculations at bottom of order form)

149.00
Insurance Tracker Software - Biller's Version 4.3 - for Windows

Unlimited Clinicians in multiple practices. Track health insurance authorizations and payments.  Stay alert to remaining sessions authorized and required reports. One click reports for each clinician. Create custom patient bills in just a few clicks. It's never been this easy. Network Capable.    $149. Delivered As A Download.
* Take $40.00 off the price of this software if purchased with the Updated CMS 1500 "Bundle" or "Bundle Plus", or Group Version (calculations at bottom of order form)

 
149.00

  Family Health Care Tracker Software - for Windows

One-click summary reports on every past medical appointment for you and each member of your family including dates, procedures, dx, and follow ups. With built-in, pre-populated drop down menus you can add to, sort data by family member. See appointment dates, reason for visit, diagnosis, treatment and follow up. In two mouse clicks retrieve all colonoscopy dates or eye exams or mammograms or PSAs or vaccinations or dental cleanings, etc., in a clear, organized, printable report. See all future scheduled appointments for your family in one report. Print your current medication list to take to an appointment. Get a printout of your relevant family medical history. Get a summary of all of your copay or deductible payments for any time period you request. Keep all clinician phones nos. and email addresses in one location for easy access.  $39.50 Delivered As A Download.

 
39.50

INSURANCE CLAIM FORMS - from prices have not changed. Shipping costs have increased.

Note that all of our forms are 100% compliant, printed to exact specs for margins, layout, paper type and ink color.
And we guarantee their compatibility with our software.

Shipping automatically calculated  if Javascript Enabled

 Quantity
Price

subTotal

500 updated CMS 1500 Forms (laser cut sheets for inkjet or laser printers) -  CMS 1500 forms no longer contain Bar-Codes

21.50
+ 12.50  S&H each
  

 
1000 updated CMS 1500 Forms (laser cut sheets for inkjet or laser printers)

 
33.50
+ 12.50  S&H each
 

Please remember to add shipping and tax (MA residents only) if you are completing this form manually

  TOTAL before discounts

 

AS A RESULT OF SKY HIGH SHIPPING COSTS, WE CANNOT AT THIS TIME OFFER THE FOLLOWING PRODUCTS:

 
2500 (case) updated CMS 1500 Forms (laser cut sheets for inkjet or laser printers)

 

 not available  
2500 (case) CONTINUOUS Claim Forms (continuous sheets for tractor feed/pinwheel printers)

 

 not available  
UB 04 Claim Forms 2500 (case) (laser cut sheets for inkjet or laser printers)
For smaller quantities (500 or 1000) contact us for pricing

 

 not available  
Window Envelopes 500 - Right Hand Window (#10/10.5) Correct for folded CMS forms.
Eliminates the need to print envelopes or make labels. The insurance co. address shows thru the window.

 

 not available  
Window Envelopes 500 -  (9X12) - RH window. Correct for unfolded claim forms.
Eliminates the need to print envelopes or make labels. The insurance co. address shows thru the window.

 

 not available  

SUPER DISCOUNT:

  If you are purchasing the Insurance Tracker Software with our EasyCMS software and forms, take $40.00 off your total

 

NON Massachusetts Residents ONLY  enter the total sale amount (after any Discounts) $

---------------------------------------------------------------------------------

Massachusetts Residents   Total sale (after any Discounts) $

  Must Add 6.25 % Sales Tax -

Amount of sale
Mass Sales Tax
Total Amount Due

 

Massachusetts Residents Total Enclosed (after any Discounts) $

Required for all Software Orders -

click the drop down arrow to highlight a choice.


Profession:
click the down arrow for additional choices
Operating System:
click the down arrow for choices

 

Word Version (MICROSOFT WORD is required for the EASYCMS 1500, UBEasy 04 and HCFA 485 products) It is NOT required for the Insurance Tracker or the Family HealthCare Tracker

If you are using a Mac, please indicate that you have the MAC version,
of Word, not the Windows Version

click the down arrow for additional choices

Type of Printer           Name and Model of your printer
   
Program To Be Used By:

Program Customization for the CMS 1500 at no charge **
Supplier's Phone number for BOX 33

Supplier's Billing Name, Address, Zip (BOX 33)**
LIMIT 3 LINES, 30 CHARACTERS PER LINE (including spaces)
New CMS rules prohibit the use of symbols or punctuation on the form. Be clear about suite or apt. nos.

** this is required info if you are purchasing the Individual Version of EASYCMS 1500

Supplier's NPI for BOX 33
Where did you learn about our program?
  scroll for additional choices     If Other, please specify
Any additional issues or requirements

payment via check or money order or PayPal - no credit cards. Contact us via email if you wish to use PayPal.

  Make checks payable to: little guy software    and send to

little guy software
125 Paradise Lane
Rochester, MA 02770

Print this order form from your Print menu or

**Click to Print this order form** and send it along with your payment

click here to  
and send payment via US Mail. IF YOU DO NOT GET A CONFIRMATION EMAIL WITHIN A FEW HOURS, WE DID NOT RECEIVE YOUR EMAIL ORDER. You should see your order form load into your email program if the order is successfully going out via email. AOL and GMAIL users should submit the order on paper via US mail OR scanned as email attachments. Email orders do not come thru properly on AOL or GMAIL.

If you have questions or difficulties with this order page,
 please contact us email   sales@littleguysoftware.com

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updated 12/6/2024