Do you have a HIPAA insurance billing template? Specifically HICFA?

You may want to take a look at these HIPAA form templates that may fit your requirement:

dental-insurance-claim-narrative

medicare-claim-form-template

dental-medical-claim-form

medical-treatment-claim-form

If these are not applicable to the requirements you've been looking for, you can always send us a request wherein you could specify the fields that the form should include. Please follow this guide How-to-Send-Request-for-Custom-Form.