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ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12) with QR Barcode, Laser-Cut Sheet, 2,500/Box

Get free shipping when you order ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12) with QR Barcode, Laser-Cut Sheet, 2,500/Box today at Quill.com. Stack coupons to get free gifts & extra discounts!
Item #: 901-CMS12LC
  Model #: CMS12LC
Brand: ComplyRight
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12) with QR Barcode, Laser-Cut Sheet, 2,500/Box
$80.99 Box
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$85.99 Box
When you buy 1
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Qty 1 2+
Price ) $85.99 $80.99
Qty. Savings 5%
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Description
  • 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: 8-1/2 x 11"
  • 2,500 per box; plastic wrapped 5 packs of 500
Specifications
Brand : ComplyRight Customizable : No Pack Qty : 2500
Weight : 25.00 lbs. per Box
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