ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 3-Part Continuous, White/White, 1,000/Pack
Item #: 901-CMS123
Model #: CMS123
Brand: ComplyRight
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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
| True Color : White | Number of Parts : 3 | Brand : ComplyRight | Customizable : No |
| Weight : 1.00 lbs. per Pack |
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