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(18 items found)
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ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 1,000 (CMS12LC1)
Item #: 901-CMS12LC1
Includes 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)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
$67.99
Per carton
Custom Carbonless CMS Forms, 8-1/2" x 11", 100 Sheets per Pad
Item #: 901-QFW1471901
For use by all medical facilities for billing insurance companies, Medicaid and Medicare; aligned with the electronic HIPAA ASC X12N 837 Non-institutional Transaction Standard
8-1/2" W x 11" L
1-part, white, carbonless; carbon paper is required for duplicates
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 500 (CMS12LC500)
Item #: 901-CMS12LC500
Includes 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)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
$35.99
Per pack
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 2,500 (CMS12LC)
Item #: 901-125557
Includes 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)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
$108.99
Per pack
Custom 2-Part Snapset CMS Forms, 8-1/2" x 11", 500 Sets per Pack
Item #: 901-QFW1471701
Snapset form for use by all medical facilities for billing insurance companies, Medicaid and Medicare; aligned with the electronic HIPAA ASC X12N 837 Non-institutional Transaction Standard
8-1/2" W x 11" L
2-part, white/canary, carbonless
Centers for Medicare and Medicaid Services Forms, 8-1/2" x 11", 250 Forms
Item #: 901-2408453
CMS-1500 claim forms (formerly known as HCFA-1500 claim forms) expedite Medicare, Medicaid or private insurance benefits
Top sensor bar for microfiche duplication, as required in some states
OCR red ink for scanning
$21.99
1-3 pack
Save 4%
$20.99
4+ pack
ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
Item #: 901-CMS12LC250
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
$37.99
Per box
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 100 Sheets
Item #: 901-CMS12650657
Designed for filing Medicare part B claims as well as claims to commercial insurance companies
Includes the newest NUCC revisions
Printed in red, scannable, OCR ink
$6.49
Per pack
TOPS CMS-1500 1 Part Health Insurance Claims 500/Pack (TOP 50126RV)
Item #: 901-309934
Satisfy record keeping requirements with these health insurance claim forms
Number of parts: 1
Contains 500 forms per package
$61.99
1-3 pack
Save 4%
$58.99
4+ pack
ComplyRight 1-Part Continuous CMS-1500 Health Insurance Claim Form (02/12), 2,500/Pack (CMS121)
Item #: 901-125542
8 1/2" x 11"
20 lb.
White
$104.99
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
$53.99
1 carton
Save 3%
$51.99
2+ carton
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
$89.99
Per box
New Customers
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
TFP UB-04 CMS-1450 1-Part Health Insurance Claims, 2500/Carton (UB04LC)
Item #: 901-519727
Designed for hospitals to file a medical claim with the patient's insurance carrier
One-part health insurance forms
Contains 2500 forms per carton
$104.99
Per carton
ComplyRight 2023 W-2C Tax Form, 1-Part, Federal Copy A, 50/Pack (531350)
Item #: 901-24507921
W-2c tax form is used to correct errors on forms W-2, W-2AS, W-2CM, W-2GU, W-2VI, or W-2c filed with the SSA
Single-part: Federal Copy A
For laser printers
$36.99
Per each
ComplyRight 2023 W-2C Employee Copy B Tax Form, 50/Pack (531450)
Item #: 901-24507952
W-2c tax form is used to correct errors on forms W-2, W-2AS, W-2CM, W-2GU, W-2VI, or W-2c filed with the SSA
Single-part: Employee Copy B
For laser printers
$39.99
Per each
ComplyRight 2023 W-2C Tax Form, 1-Part, Copy 2/C, 50/Pack (531650)
Item #: 901-24507902
W-2c tax form is used to correct errors on forms W-2, W-2AS, W-2CM, W-2GU, W-2VI, or W-2c filed with the SSA
Single-part: Copy 2/C
For laser printers
$24.99
Per each
ComplyRight 2023 W-2C Tax Form, 1-Part, Copy 1/D, 50/Pack (531550)
Item #: 901-24507905
W-2c tax form is used to correct errors on forms W-2, W-2AS, W-2CM, W-2GU, W-2VI, or W-2c filed with the SSA
Single-part: Copy 1/D
For laser printers
$22.99
Per each