Customers also viewed
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12), 2-Part Continuous, White/White, 1,000/Box
$75.99
1 box
Save 3%
$72.99
2+ box
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 1-Part Continuous, 1,000/Carton
$51.99
1 carton
Save 3%
$49.99
2+ carton
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 1-Part Continuous, 1,000/Carton
Item #:
901-CMS1211
Model #:
CMS1211
Brand:
ComplyRight
Frequently bought together
+
+
Total
$120.97
$51.99
1 carton
Save 3%
$49.99
2+ carton
Customers Also Viewed
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 100 Sheets
Item #: 901-CMS12650657
Centers for Medicare and Medicaid Services Forms, 8-1/2" x 11", 250 Forms
Item #: 901-2408453
Description
Approved by the National Uniform Claim Committee (NUCC) and is HIPAA compliant.
- 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"
- 1,000 per carton
Specifications
Brand
ComplyRight
HR Form Pack Size
1000
HR Form Type
Cms-1500
Number of Parts
1
True Color
White
Accessories
