close popup
Skip to main content
Skip to footer
QuillPLUS Blue
Can you use an extra $850 annually? Become a member today.
Close

ComplyRight CMS-1500 Health Insurance Claim Form (02/12), 1000/Carton (CMS12LC1)

Get free shipping when you order ComplyRight CMS-1500 Health Insurance Claim Form (02/12), 1000/Carton (CMS12LC1) today at Quill.com. Stack coupons to get free gifts & extra discounts!
Item #: 901-CMS12LC1
  Model #: CMS12LC1
Brand: TFP
ComplyRight CMS-1500 Health Insurance Claim Form (02/12), 1000/Carton (CMS12LC1)
Delivery Date:

Enter Zip Code
Parcel
Description
This form was revised to align the paper form with some of the changes in the electronic health care claims: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1)
  • Approved by the National Uniform Claim Committee (NUCC); HIPAA compliant
  • The most significant change was the addition of 8 diagnosis codes in field 21
  • Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
  • Printed with OCR "dropout" red ink on 20lb. paper (per government regulations)
  • Form not available personalized
  • Certified Chain of Custody; promotes sustainable forest management
  • Size: 8-1/2 x 11"
  • 1,000 per carton
Specifications
Brand : TFP Customizable : No HR Form Pack Size : 1000 HR Form Type : Cms-1500
Number of Parts : 1 Pack Qty : 1000 True Color : White
Weight : 11.00 lbs. per Carton
loadingLoading...