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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
$52.99
Per carton
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2 x 11, Box of 2,500 (CMS12LC)ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2 x 11, Box of 2,500 (CMS12LC)
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 2,500 (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
$98.99
Per pack
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
$29.99
Per box
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
$35.99
Per pack
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
$199.99
Per 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
$92.99
Per carton
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
$15.59
Per pack
ComplyRight™ Massachusetts Job Application, Pack of 50 (A2179MA)ComplyRight™ Massachusetts Job Application, Pack of 50 (A2179MA)
ComplyRight™ Massachusetts Job Application, Pack of 50 (A2179MA)
Item #: 901-1182882EDI
Written by Employment Attorneys to ensure compliance with your state laws
Gathers the maximum amount of information and exposes “red flags” without crossing into illegal territory
Includes tip sheet with HR best practices and compliance guidelines
$81.99
Per pack
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
$24.59
Per pack
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
$32.99
Per pack
ComplyRight 1-Part Employee Personal Files 25/Pack (A0503)
ComplyRight 1-Part Employee Personal Files 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
$102.99
Per each
ComplyRight 2024 Attendance Calendar Card, White, Pack of 50 (A4000W50)ComplyRight 2024 Attendance Calendar Card, White, Pack of 50 (A4000W50)
ComplyRight 2024 Attendance Calendar Card, White, Pack of 50 (A4000W50)
Item #: 901-2548988
Calendar format on front of form makes noting absences quick and easy
Simple coding system included to aid in quickly identifying troubling patterns
Provides legal "backup" for personnel decisions, such as disciplinary action or termination
$76.99
Per pack
New Customers
675 points
Limit 1
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Centers for Medicare and Medicaid Services Forms, 8-1/2 x 11, 250 Forms
Centers for Medicare and Medicaid Services Forms, 8-1/2" x 11", 250 Forms
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
$21.99
Per pack
ComplyRight 1-Part Continuous CMS-1500 Health Insurance Claim Form (02/12), 2,500/Pack (CMS121)ComplyRight 1-Part Continuous CMS-1500 Health Insurance Claim Form (02/12), 2,500/Pack (CMS121)
ComplyRight 2024 Attendance Calendar Card, White, Pack of 25 (A4000W25)ComplyRight 2024 Attendance Calendar Card, White, Pack of 25 (A4000W25)
ComplyRight 2024 Attendance Calendar Card, White, Pack of 25 (A4000W25)
Item #: 901-2548993
Calendar format on front of form makes noting absences quick and easy
Simple coding system included to aid in quickly identifying troubling patterns
Provides legal "backup" for personnel decisions, such as disciplinary action or termination
$62.99
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
$25.99
Per box
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
$11.99
Per pack
ComplyRight Federal and State Remote Worker Binder 1-Year Labor Law Service, Texas, Spanish (U1200CRComplyRight Federal and State Remote Worker Binder 1-Year Labor Law Service, Texas, Spanish (U1200CR
ComplyRight Federal and State Remote Worker Binder 1-Year Labor Law Service, Texas, Spanish (U1200CRWTXESP)
Item #: 901-2549038
FEDERAL COMPLIANCE ALERT: June 27, 2023, the Pregnant Workers Fairness Act (PWFA) requires covered employers to post a notice describing the law’s protections (revised “Know Your Rights” poster). Also, May 4, 2023, the Department of Labor released a
mandatory update to the FLSA/Federal Minimum Wage poster, adding details regarding break times for nursing employees. All ComplyRight posters and services that cover federal postings now include the updated versions of these mandatory postings ...
High quality printed version of mandatory federal and state posters
$87.99
Per each
ComplyRight 1-Part Personnel Folder, 25/Pack (A223)
ComplyRight 1-Part Personnel Folder, 25/Pack (A223)
Item #: 901-1949180
Personnel folder keeps quick information on the outside and confidential records on the inside
One-part personnel folder
Contains 25 folders per package
$96.99
Per 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
$132.99
Per each
Medical Arts Press® Log of Hospital Visits; Pocket-sized, 1-PartMedical Arts Press® Log of Hospital Visits; Pocket-sized, 1-Part
Medical Arts Press® Log of Hospital Visits; Pocket-sized, 1-Part
Item #: 901-20030
Updated with new 2010 consult codes and helpful chart on inside front cover
Make a check mark or write in the level of code for each patient visit
When patient is discharged, detach and give to billing - it's virtually foolproof
$64.99
1 pack
Save 3%
$62.99
2+ pack
ComplyRight Patient Acknowledgment of Receipt of Privacy Practices Notice (A1354)
ComplyRight Patient Acknowledgment of Receipt of Privacy Practices Notice (A1354)
Item #: 901-398026
Attorney approved form acknowledging patient has received a Notice of Privacy Practices from his or her healthcare provider
HIPAA compliant
Size: 8 1/2" x 11"
$59.99
Per pack
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12), 2-Part Continuous, White/Yellow, 1,000/Bo
ComplyRight Employee Record Organizer for Small Business, 3-Folder Set (A3103)ComplyRight Employee Record Organizer for Small Business, 3-Folder Set (A3103)
ComplyRight Employee Record Organizer for Small Business, 3-Folder Set (A3103)
Item #: 901-1949185TFP
Contains 3 folders: Hiring/Employment History, Payroll/Tax and Benefits/Insurance
Back side of organizer jacket explains what records you must keep and for how long
Organizer: 9.5" x 11.875" x 1.75"
$125.99
Per each
1 2

Displaying 1-144 of 146
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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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