ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 3-Part Continuous, White/White, 1,000/Pack

Name: ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 3-Part Continuous, White/White, 1,000/Pack
Brand: ComplyRight
SKU: 357901
Availability: InStock

Item #: 901-CMS123

Model #: CMS123

Brand: ComplyRight

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ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 3-Part Continuous, White/White, 1,000/Pack

$81.99 Pack

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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"
1,000 per box

Specifications

Brand : ComplyRight	Customizable : No	HR Form Pack Size : 1000	HR Form Type : Cms-1500
Number of Parts : 3	True Color : White
Weight : 28.30 lbs. per Pack