close popup
Skip to main content
Skip to footer

Quill+

$34.99 paper price + exclusive monthly coupons + free shipping. Tell Me More

Close

ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); Laser-Cut Sheet, 250/Box

Buy ComplyRight CMS-1500 Health Insurance Claim Forms on Quill.com. Ensure your insurance claims are up-to-date with 250 forms/box.
Item #: 901-CMS12LC250
  Model #: null
Brand: ComplyRight
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); Laser-Cut Sheet, 250/Box
Enter Zip Code

Estimated Delivery Date:
Parcel
Description
  • 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"
  • 250 per box
Specifications
Brand : ComplyRight Customizable : No HR Form Pack Size : 250 HR Form Type : Cms-1500
Pack Qty : 250 True Color : White
Weight : 2.50 lbs. per Box
loadingLoading...