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   (106 Products)
All filters 106 items found
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2 x 11, Box of 1,000 (CMS12LC1)ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2 x 11, Box of 1,000 (CMS12LC1)
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 1,000 (CMS12LC1)
Item #: 901-CMS12LC1
Includes 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)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
$80.59
Per carton
($0.08/EACH)
ComplyRight CMS-1500 Health Insurance Claims, 2500/Pack (CMS12LC)ComplyRight CMS-1500 Health Insurance Claims, 2500/Pack (CMS12LC)
ComplyRight CMS-1500 Health Insurance Claims, 2500/Pack (CMS12LC)
Item #: 901-125557
Includes 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)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
$120.09
Per pack
($0.05/EACH)
ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
Item #: 901-CMS12LC250
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
$43.59
Per box
($0.17/EACH)
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2 x 11, Pack of 500 (CMS12LC500)ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2 x 11, Pack of 500 (CMS12LC500)
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 500 (CMS12LC500)
Item #: 901-CMS12LC500
Includes 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)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
$49.99
Per pack
($0.10/EACH)
Adams Employment Applications, 50/Pad, 2 Pads/Pack (ABF 9661)Adams Employment Applications, 50/Pad, 2 Pads/Pack (ABF 9661)
Adams Employment Applications, 50/Pad, 2 Pads/Pack (ABF 9661)
Item #: 901-9661
Includes the necessary information for every type of position
Contains 50 two-sided forms per pad, two pads per package
Perfect contrast of blue ink on white paper
$30.79
Per pack
($15.40/PAD)
TOPS Employee Record Master File, 20/Pack (TOP 3280)
TOPS Employee Record Master File, 20/Pack (TOP 3280)
Item #: 901-3280Q
Employee personal file includes all you need to build a complete employee record
20 personal files per pack
Comes in manila color with blue ink
$59.49
1-3 pack
($2.97/EACH)
Save 5%
$55.99
4+ pack
($2.80/EACH)
TOPS Centers for Medicare and Medicaid Services Forms, 8-1/2 x 11, 250/Pack (50135RV)
TOPS Centers for Medicare and Medicaid Services Forms, 8-1/2" x 11", 250/Pack (50135RV)
Item #: 901-2408453
CMS-1500 claim forms (formerly known as HCFA-1500 claim forms) expedite Medicare, Medicaid or private insurance benefits
Top sensor bar for microfiche duplication, as required in some states
OCR red ink for scanning
$35.09
Per pack
($0.14/EACH)
Adams 1 Part Employee Personal Files, 20/Pack (9287ABF)Adams 1 Part Employee Personal Files, 20/Pack (9287ABF)
Adams 1 Part Employee Personal Files, 20/Pack (9287ABF)
Item #: 901-9287
The employee personnel file folder is complete with space for any case
Number of parts: 1
Contains 20 per pack for bulk purchasing
$16.89
Per pack
($0.84/EACH)
ComplyRight™ Expanded Employee Records Folder, Letter Size, Pack of 25 (A5008)ComplyRight™ Expanded Employee Records Folder, Letter Size, Pack of 25 (A5008)
ComplyRight™ Expanded Employee Records Folder, Letter Size, Pack of 25 (A5008)
Item #: 901-1949181
Made in the U.S.A of thick, long-lasting manila card stock
Developed by Employment Attorneys for 100% Compliance
Expanded folder has 1.5” spine which holds more than 100 employee documents
$161.49
1-2 each
Save 18%
$130.99
3+ each
ComplyRight Personnel Folder, 6-Part , 25 Forms/Pack (A1175)ComplyRight Personnel Folder, 6-Part , 25 Forms/Pack (A1175)
ComplyRight Personnel Folder, 6-Part , 25 Forms/Pack (A1175)
Item #: 901-1949186TFP
Expandable organizer offers convenient, comprehensive record-keeping
Contains six different file folders per organizer
Contains 25 organizers per package including one outer jacket and six tabbed folders each
$257.09
1-3 each
Save 9%
$232.99
4+ each
ComplyRight 1-Part Confidential Employee Record Folder, 25/Pack (A0503)
ComplyRight 1-Part Confidential Employee Record Folder, 25/Pack (A0503)
Item #: 901-2549341
Comprehensive employee record folder helps to ensure the safety of private employee data
Number of parts: 1
Contains 25 files per package
$135.99
Per each
ComplyRight 1-Part Personnel Folder, 25/Pack (A222)
ComplyRight 1-Part Personnel Folder, 25/Pack (A222)
Item #: 901-1949183
Expandable confidential personnel folder protects legally sensitive information
One-part personnel folder
Contains 25 files per package
$139.09
1-2 each
Save 18%
$112.99
3+ each
ComplyRight™ Employee Records Folder, Letter Size, Pack of 25 (A5001)ComplyRight™ Employee Records Folder, Letter Size, Pack of 25 (A5001)
ComplyRight™ Employee Records Folder, Letter Size, Pack of 25 (A5001)
Item #: 901-1949184
Made in the U.S.A of thick, long-lasting manila card stock
Developed by Employment Attorneys for 100% Compliance
Easily fits into any filing cabinet or desk drawer
$98.69
1-2 each
Save 8%
$89.99
3+ each
TFP UB-04 CMS-1450 1-Part Health Insurance Claims, 2500/Carton (UB04LC)
TFP UB-04 CMS-1450 1-Part Health Insurance Claims, 2500/Carton (UB04LC)
Item #: 901-519727
Designed for hospitals to file a medical claim with the patient's insurance carrier
One-part health insurance forms
Contains 2500 forms per carton
$118.89
Per carton
($0.05/EACH)
ComplyRight Payroll Change Notice, 3-Part, Pack of 50 (A2170)
ComplyRight Payroll Change Notice, 3-Part, Pack of 50 (A2170)
Item #: 901-2548967
Helps ensure changes are properly processed (through payroll, for example)
Provides written record of what is changing about status and why
Provides two extra copies for employee and for recordkeeping
$100.89
Per each
ComplyRight™ Personnel Pocket File Folder, Pack of 25 (A1202)ComplyRight™ Personnel Pocket File Folder, Pack of 25 (A1202)
ComplyRight™ Personnel Pocket File Folder, Pack of 25 (A1202)
Item #: 901-1949182
Made in the U.S.A of thick, long-lasting manila card stock
Developed by Employment Attorneys for 100% Compliance
Extended tab on folder helps easily locate employee from file cabinets
$92.39
1-2 each
Save 6%
$85.99
3+ each
Adams Time Sheets, 100/Pad, 2 Pads/Pack (ABF 9507ABF)
Adams Time Sheets, 100/Pad, 2 Pads/Pack (ABF 9507ABF)
Item #: 901-124495
Track weekly time, including morning, afternoon, and overtime using these time sheets
Number of parts: 1
Contains 100 sheets per pad, two pads per package
$13.89
Per pack
TOPS® Application for Employment, 2-Sided, 8-1/2 x 11, 50 Sheets/Pad, 2 Pads/Box (32851)TOPS® Application for Employment, 2-Sided, 8-1/2 x 11, 50 Sheets/Pad, 2 Pads/Box (32851)
TOPS® Application for Employment, 2-Sided, 8-1/2 x 11", 50 Sheets/Pad, 2 Pads/Box (32851)
Item #: 901-370031
2-hole punched
Application complies with all legal requirements
Includes employment history, references, education, personal information, physical record, check-offs for special questions and space for interviewer's remarks
$40.39
1-3 box
Save 5%
$37.99
4+ box
ComplyRight Performance Appraisal, 50 Forms/Pack (A2192)
ComplyRight Performance Appraisal, 50 Forms/Pack (A2192)
Item #: 901-2548974
Helps you communicate your expectations clearly and provides employees with a tangible way to gauge their progress
Creates a consistent, timesaving review process
Attorney-developed to ensure 100% compliance
$75.39
Per each
ComplyRight Employee Warning Notice, Pack of 50 (A2311)
ComplyRight Employee Warning Notice, Pack of 50 (A2311)
Item #: 901-2548932
Includes action to be taken, as well as explains the consequences of repeat offenses
Includes ComplyRight™ tips for optimal, compliant use
Pack of 50 forms
$51.99
Per each
ComplyRight Payroll Change Notice Forms (AR0394)
ComplyRight Payroll Change Notice Forms (AR0394)
Item #: 901-712138
Ensures all employees have updated, current payroll records
Size: 8 1/2" X 11"
50 per pack
$43.59
1-2 pack
Save 5%
$40.99
3+ pack
ComplyRight Employee Separation Forms (AR0373)
ComplyRight Employee Separation Forms (AR0373)
Item #: 901-712163
50 Pack
Size: 81/2” x 11”
8 1/2" x 11"
$43.59
1-2 pack
Save 5%
$40.99
3+ pack
ComplyRight Compact 2-Part Absence Report, Pack of 50 (A2151)
ComplyRight Compact 2-Part Absence Report, Pack of 50 (A2151)
Item #: 901-2548978
Attorney-developed to ensure 100% compliance
Features ComplyRight™ tips for optimal, compliant use
Includes space to add your own comments
$63.69
Per each
ComplyRight™ HIPAA Notice of Privacy Practices Poster (A2123)
ComplyRight™ HIPAA Notice of Privacy Practices Poster (A2123)
Item #: 901-728245
Communicates mandatory HIPAA rules to patients
Laminated
Informs patients of their rights and responsibilities under HIPAA regulations
$27.59
Per each
1 2345

Displaying 1-24 of 106
Want to know more about Shop HR Forms

Medical claim forms as paper submissions

Medical practices must submit full, accurate information to receive payment from insurance providers. The 1500 form captures all the information that HCFA requires to assess reimbursements administered under the Centers for Medicare and Medicaid Services (CMS). HCFA 1500 forms also contain the data points that private insurers need for assessing reimbursements. Practice personnel may hand-print the information in dark ink or use a non-italic, black 10- or 12-point font on a dot matrix or laser printer.

The color format of HCFA 1500 forms

This medical claim form is just one page. Like many tax forms that the IRS requires for specific paper filing, the 1500 form has red ink on white paper to enable the CMS to scan it for computer data entry. Medical practices may also use only the red-ink copy as the original.

Some of the information on medical claim forms

If a medical practice does use the correct medical claim form or if it doesn’t complete the paperwork strictly according to guidelines, the CMS won’t process the form for government reimbursement. Private insurers may also deny the form and make the reimbursement process more difficult. Some of the information requirements are the following:

  • Patient’s name and Medicare number exactly as they appear on the Medicare card
  • Full, 10-digit Provider Identification Number of the practice, including the National Provider Identifier (NPI) for any referring provider
  • Valid address and ZIP code for the location of the service provided, not a P.O. box or “Same as Above”
  • Exact certification number for the service provided and any clinical laboratory participating in the service
  • Strict compatibility between units/days of service provided and the quantity/date of service

Confidentiality of the 1500 form

Data privacy provisions under HIPAA require that patient identities remain confidential. Medical practices that make copies of the 1500 claim form must file the copies where unauthorized personnel cannot access them. Use confidential folders like those that companies use to separate employees’ medical records from their personnel records. These serve as record-keeping safeguards for adhering to legal standards for patient privacy.

Cost-saving 1500 form packages

Like the large number of HR forms that private companies must have for employees, a medical practice must have plenty of documents for its patients, including those for submitting claims. Authorized 1500 form printers like ComplyRight™ provide cost-saving packages ranging from 250 to 1,000 and 2,500 forms.

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