close popup
Skip to main content
Skip to footer
quill points image
Turn every order into a gift. Join Today!
Close

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

Get free shipping when you order ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 3-Part Continuous, White/White, 1,000/Pack today at Quill.com. Stack coupons to get free gifts & extra discounts!
Item #: 901-CMS123
  Model #: CMS123
Brand: ComplyRight
Not yet rated.Be the first to Write a Review!
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 3-Part Continuous, White/White, 1,000/Pack
Delivery Date:

Enter Zip Code
Parcel
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 Number of Parts : 3 True Color : White
Weight : 28.30 lbs. per Pack
loadingLoading...