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ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 1-Part Continuous, 1,000/Carton
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 1-Part Continuous, 1,000/Carton
$51.99
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Save 3%
$49.99
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  1. Paper
  2. Forms & Recordkeeping
  3. Forms & Recordkeeping
  4. HR Forms
  5. Dot-Matrix Health Insurance Forms

ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 1-Part Continuous, 1,000/Carton

Order ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 1-Part Continuous, 1,000/Carton today at Quill.com and get fast shipping. Stack coupons to get free gifts & extra discounts!
Item #: 901-CMS1211
Model #: CMS1211
Brand: ComplyRight
(2 reviews)
Item #: 901-CMS1211
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 1-Part Continuous, 1,000/Carton
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$51.99
1 carton
Save 3%
$49.99
2+ carton

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Approved by the National Uniform Claim Committee (NUCC) and is HIPAA compliant.
  • 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 health care 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"
  • 1,000 per carton
Brand
ComplyRight
Form Size
8 1/2" x 11"
Length in Inches
11
Medical Form Pack Size
1000
Medical Form Type
Health Insurance Claims
Number of Parts
1
Pack Qty
1
Print Type
Continuous
Series or Collection
Cms-1500
Width in Inches
8.5

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