Skip to main content Skip to footer
Track an order
Shared cart
Reward not redeemed
You dont have enough points to redeem this reward.
Favorite list
Alternative Items
ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
Per box

  1. Paper
  2. Forms & Recordkeeping
  3. Forms & Recordkeeping
  4. HR Forms
  5. HCFA CMS-1500 Laser Health Insurance Forms

ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)

Buy ComplyRight CMS-1500 Health Insurance Claim Forms on Quill.com. Ensure your insurance claims are up-to-date with 250 forms/box.
Item #: 901-CMS12LC250
Model #: null
Brand: ComplyRight
(46 reviews)
Item #: 901-CMS12LC250
ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)

Frequently bought together

Total $133.97
Per box

Upgrade to get 5% off, earn points 10% faster, and more!

Free shipping

Ship to : 60069
Estimated delivery by: Thu 12/7/2023 - Mon 12/11/2023

Free shipping

Request quote

Customers also viewed

Meet billing requirements for Medicare part B using these ComplyRight CMS-1500 health insurance claim forms. Use these easy-to-read insurance claim forms for a faster claims process. Printed in scannable, dropout OCR red ink, these documents deliver crisp, clean text and comply with CMS standards and requirements for paper, layout and ink to expedite the receipt of payment for health care facilities. These ComplyRight CMS-1500 forms include 02/12 NUCC revisions and replace the previous 08/05 version.
  • 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
  • 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"
  • Laser-cut sheet
  • 250 per box
Form Size
8 1/2" x 11"
Length in Inches
Medical Form Pack Size
Medical Form Type
Health Insurance Claims
Print Type
Quick Ship
Series or Collection
True Color
Width in Inches

Quill help center

Call us 1-800-982-3400

New to Quill? Would you like to learn more about how we can help your business?

Subtotal: ( items / rewards):
Rewards balance:
Loading your cart
Quick view
Shared Cart Details
Please review this product
Upgrade to Rewards+
Member benefits
Free shipping-no minimum
As a member, you never have to worry about hitting an order minimum
View policy

5% off everyday low prices
Sales not included

Plus, save an additional 5% off our best 10-ream paper price

Earn 10% more points for every $1 spent

Exclusive Rewards+ offers

Site-wide price match
View policy

Receive 30 extra days to use your points

Offers and discounts exclude HP,Samsung and Epson. We offer a worry-free enrollment guarantee - if you are not satisfied with your Rewards+ membership, you can cancel at any time for a prorated refund. By enrolling into the Reward+ program, you are agreeing to the Terms and Conditions.

See full membership details