CMS 1500 Laser Health Insurance Forms (02/12 Version); 2500/Box

See pricing info, deals and product reviews for CMS 1500 Laser Health Insurance Forms (02/12 Version); 2500/Box at Order online today and get fast, free shipping for your business.
Item # 901-CMS12LC
  Model # CMS12LC
• Form Type: Billing • Format: Health Insurance Claim Form • Sheet Size: 8-1/2" x 11"
100% of respondents would recommend this
When you buy 2+
$84.99 Total Price
Buy more & save!
Qty 1 2
Price $84.99 $79.99
Save 5%
This Item qualifies for FREE Shipping*
Your delivery dates will be verified at checkout
Delivery Date:
Enter Zip Code Parcel

  • 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: 8-1/2x11"
  • 2,500 per box
  • To view the 02/2012 proposed changes for this product Click Here

Customers also bought

Close Message