ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 1-Part Continuous, 1,000/Carton
Item #:
901-CMS1211
Model #:
CMS1211
Brand:
ComplyRight
(2 reviews)
Item #:
901-CMS1211
Out of stock
$58.99
1 carton
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$56.99
2+ carton
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Product details
Reviews
Length in Inches
Medical Form Pack Size
Medical Form Type
Number of Parts
Width in Inches
Acid Free
Brand
Pack Qty
Print Type
Quick Ship
Series or Collection
True Color
Form Size
$56.99 carton
When you buy 2+
Currently out of stock
11
1000
Health Insurance Claims
1
8.5
N/A
ComplyRight
1
Continuous
Cms-1500
N/A
8 1/2" x 11"
N/A
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Description
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
Specifications
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
Accessories
