Shop dental claim forms
(29 items found)
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ComplyRight 2024 ADA Dental Claim Forms, 100 Forms/Pack (20241100)
Item #: 901-24602229
Forms conform to the Health Insurance Portability and Accountability Act (HIPAA)
Forms provide a common format for reporting dental services to a patient's dental benefit plan
ADA policy promotes use and acceptance latest version ADA Dental Claim Forms by dentists and payers
ComplyRight 2024 ADA Dental Claim Forms, 500 Forms/Pack (20241500)
Item #: 901-24602228
Forms conform to the Health Insurance Portability and Accountability Act (HIPAA)
Forms provide a common format for reporting dental services to a patient's dental benefit plan
ADA policy promotes use and acceptance latest version ADA Dental Claim Forms by dentists and payers
ComplyRight 2024 ADA Dental Claim Forms, 1,000 Forms/Pack (202411)
Item #: 901-24602227
Forms conform to the Health Insurance Portability and Accountability Act (HIPAA)
Forms provide a common format for reporting dental services to a patient's dental benefit plan
ADA policy promotes use and acceptance latest version ADA Dental Claim Forms by dentists and payers
ComplyRight 2024 ADA Dental Claim Forms, 2,500 Forms/Pack (20241)
Item #: 901-24602226
Forms conform to the Health Insurance Portability and Accountability Act (HIPAA)
Forms provide a common format for reporting dental services to a patient's dental benefit plan
ADA policy promotes use and acceptance latest version ADA Dental Claim Forms by dentists and payers
Medical Arts Press Registration Forms without Updates Section ; Brush Silhouette
Item #: 901-21786
Comprehensive form gathers complete insurance information, making it easier for you to process claims
Silhouetted toothbrush design welcomes patients
Printed in 1-color on two sides on 24-lb. white bond paper
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
Medical Arts Press Registration Form; Smile Team
Item #: 901-21784
Comprehensive form gathers complete insurance information, making it easier for you to process claims
Friendly "happy teeth" design welcomes patients
Printed in 2-color on two sides on 24-lb. white bond paper
$80.29
1 pack
($0.32/EACH)
Save 7%
$74.79
2+ pack
($0.30/EACH)
Medical Arts Press Dental Registration Forms, 250/Pack (20558)
Item #: 901-20558NP
Type of form: Dental registration form
250 per pack
Size: 8 1/2" x 11"
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
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
Medical Arts Press® Dental Registration and History Form; Tooth Border, 250 Sheets/Pack (20596)
Item #: 901-20596
HIPAA compliant insurance authorization
Help ensure reimbursement and improve risk management
Collects printed name and relationship to patient
Medical Arts Press® Dental Treatment Consent Form; 1-Sided
Item #: 901-20606
Provides your patient complete information about their treatment and its risks
Obtains written consent for your records
Just check off applicable conditions; patient reads explanation, initials and signs
ComplyRight CMS-1500 Health Insurance Claims, 2500/Pack (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
ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
Item #: 901-24614845
Designed for hospitals to file a medical claim with the patient's insurance carrier
One-part health insurance forms
Printed with OCR dropout red ink on white paper
Adams CMS-1500 1 Part Health Insurance Claims, 100/Pack (ABF CMS1500L1V)
Item #: 901-486075
Satisfy record keeping requirements with these health insurance claim forms
Number of parts: 1
Contains 100 forms per package
TOPS CMS-1500 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
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
Custom Dental Registration Forms, 8-1/2" x 11", 250 Sheets per Pack
Item #: 901-QFW2055801
Includes complete personal and insurance information, and assignment and release for easy account set up
8-1/2" W x 11" L
White 24# bond stock, pre-printed in black and blue ink
TOPS Centers for Medicare and Medicaid Services Forms, 8-1/2" x 11", 250/Pack (50135RV)
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
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
Custom Dental Charge Slips, 4" x 5-1/2", 100 Sheets per Pad
Item #: 901-QFN131151R
Use to provide costs and services to patients
4" W x 5-1/2" L
White 20# text stock; printed in black ink
Custom Carbonless 2-Part Dental Diagnosis and Estimate Forms, 8-1/2" x 11", 250 Sheets per Pack
Item #: 901-QFN102621R
For use in providing estimates and treatment plans
8-1/2" W x 11" L
2-part, white/canary, carbonless; printed in black ink
Medical Arts Press Dental Registration Forms Featuring Updates Section; Sky Blue, Spanish (20743)
Item #: 901-20743
Collects printed name and relationship to patient
Medication list requests correlating diagnosis
Screens for artificial heart valves, artificial joints, heart
