ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
$43.59
Per box
ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
Item #:
901-CMS12LC250
Model #:
CMS12LC250
Brand:
ComplyRight
(47 reviews)
Item #:
901-CMS12LC250
$43.59
Per box
1 BOX = 250 EACH
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ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
Description
Meet billing requirements for Medicare part B using these ComplyRight CMS-1500 health insurance claim forms.
Use these easy-to-read insurance claim forms for a faster claims process. Printed in scannable, dropout OCR red ink, these documents deliver crisp, clean text and comply with CMS standards and requirements for paper, layout and ink to expedite the receipt of payment for health care facilities. These ComplyRight CMS-1500 forms include 02/12 NUCC revisions and replace the previous 08/05 version.
- Approved by the National Uniform Claim Committee (NUCC); HIPAA compliant
- This form was revised to align the paper form with some of the changes in the electronic healthcare claims: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1)
- 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"
- Laser-cut sheet
- 250 per box
Specifications
Brand
ComplyRight
Form Size
8 1/2" x 11"
Length in Inches
11
Medical Form Pack Size
250
Medical Form Type
Health Insurance Claims
Print Type
Laser
Series or Collection
CMS-1500
Shipping
2-day
True Color
White
Width in Inches
8.5
Accessories
