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ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12), 2-Part Continuous, White/Yellow, 1,000/Box
Item #: 901-CMS122
8 1/2" x 11"
20 lb.
White
$118.99
Per box
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 1-Part Continuous, 1,000/Carton
Item #: 901-CMS1211
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
$59.99
1 carton
Save 3%
$57.99
2+ carton
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12), 2-Part Continuous, White/White, 1,000/Box
Item #: 901-CMS12W2
Printed with OCR "dropout" red ink on 20# paper, as per government regulations
1,000 per case
Form is "8.5x11"
$86.99
Per box
