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ComplyRight CMS-1500 Health Insurance Claim Form (02/12), 1000/Carton (CMS12LC1)
Item #: 901-CMS12LC1
Model #: CMS12LC1
Brand: TFP
$49.99
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Description
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)
- Approved by the National Uniform Claim Committee (NUCC); HIPAA compliant
- 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 : TFP | Customizable : No | HR Form Pack Size : 1000 | HR Form Type : Cms-1500 |
| Number of Parts : 1 | Pack Qty : 1000 | True Color : White | |
| Weight : 11.00 lbs. per Carton |
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