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1500 claim forms

  (19 items found)
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ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); Laser-Cut Sheet, 2,500/Box

ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); Laser-Cut Sheet, 2,500/Box

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
$79.99 Box
When you buy 2+
Item # 901-CMS12LC
Quick Ship: 1-2 business day delivery
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); Laser-Cut Sheet, 1000/Carton

ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); Laser-Cut Sheet, 1000/Carton

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
$49.99 Carton
Item # 901-CMS12LC1
Quick Ship: 1-2 business day delivery
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); Laser-Cut Sheet, 250/Box

ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); Laser-Cut Sheet, 250/Box

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
$13.99 Box
Item # 901-CMS12LC250
Quick Ship: 1-2 business day delivery
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

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
$26.99 Pack
Item # 901-2408453
CMS Form 1500 Rev. 02/12 Claim Form, 8-1/2 x 11, 1-Part, 100 Forms, Personalized (14719)

CMS Form 1500 Rev. 02/12 Claim Form, 8-1/2" x 11", 1-Part, 100 Forms, Personalized (14719)

1 part form for use by all medical facilities/entities billing insurance companies, Medicaid and Medicare
Laser cut and printed on white paper, carbonless
Includes 100 forms
$13.29 Pad
When you buy 20+
Customize
Item # 901-14719
CMS Form 1500 Rev. 02/12 Claim Form; 2-Part Snapset, Personalized

CMS Form 1500 Rev. 02/12 Claim Form; 2-Part Snapset, Personalized

Accommodates reporting of the National Provider Identifier (NPI) number
Approved by the AMA’s Council on Medical Services and CMS
Better aligned with the electronic HIPAA ASC X12N 837 Non-institutional Transaction Standard
$136.99 Box
When you buy 8+
Customize
Item # 901-14717
SS Health Insurance Claim Form Window Env

Standard Claim Right Window Envelopes; 9-1/2Wx4-1/2H", Self-Seal, 500/Box

Specially designed window envelopes fit CMS 1500 claim forms when tri-folded
All envelopes have confidential lining for added security
Compatible with laser printers
$37.99 Box
When you buy 3+
Item # 901-1500ESMAP
Lifetime Warranty
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 1-Part Continuous, 1,000/Carton

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

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
$47.99 Carton
When you buy 2+
Item # 901-CMS1211
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 2-Part Continuous with Label, 1,000/Carto

ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 2-Part Continuous with Label, 1,000/Carton

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
$96.99 Carton
When you buy 2+
Item # 901-CMS122B
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 1-Part Continuous with Label, 1,000/Carto

ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 1-Part Continuous with Label, 1,000/Carton

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
$68.99 Carton
When you buy 2+
Item # 901-CMS121B
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 3-Part Continuous, White/White, 1,000/Pac

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

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
$81.99 Pack
Item # 901-CMS123
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12), 2-Part Continuous, White/White, 1,000/Box

ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12), 2-Part Continuous, White/White, 1,000/Box

Printed with OCR "dropout" red ink on 20# paper, as per government regulations
1,000 per case
Form is "8.5x11"
$84.99 Box
When you buy 2+
Item # 901-CMS12W2
Item # 901-CMS122
TOPS CMS-1500 1 Part Health Insurance Claims 500/Pack (TOP 50126RV)

TOPS CMS-1500 1 Part Health Insurance Claims 500/Pack (TOP 50126RV)

Satisfy record keeping requirements with these health insurance claim forms
Number of parts: 1
Contains 500 forms per package
$48.99 Pack
Item # 901-309934
Health Insurance Claim Form Window Envelopes, Self-Seal, 9 1/2Wx4 1/2H, 500/Box

Health Insurance Claim Form Window Envelopes, Self-Seal, 9 1/2Wx4 1/2"H, 500/Box

Self seal CMS-1500 right window envelope
HIPAA security tent, 24 lb. bond paper
4 1/2" x 9 1/2"
$44.99 Box
When you buy 3+
Item # 901-1500ESQ
Health Insurance Claim Form Window Envelopes, Self-Seal, Top Loading, 9Wx12-1/2H, 100/Box

Health Insurance Claim Form Window Envelopes, Self-Seal, Top Loading, 9Wx12-1/2"H, 100/Box

24 lb.
Self seal CMS-1500 jumbo envelope, right window position
Size: 9" x 12 1/2"
$28.99 Pack
When you buy 3+
Item # 901-1500LRQQ
Health Insurance Claim Form Window Envelopes, Gummed, 9-1/2Wx4-1/2H, 500/Box
$29.99 Box
When you buy 3+
Item # 901-1500EQ
Item # 901-2708506
Optum 360,  EncoderPro.com for Payers, (1145)

Optum 360,  EncoderPro.com for Payers, (1145)

Optum360 CodeLogicTM search engine. Find and validate CPT®, HCPCS, ICD-9-CM and ICD-10-CM/PCS codes using lay terms, acronyms, abbreviations, and even the misspelled words found on outpatient and inpatient UB-04s and providers’ CMS-1500 claim forms.
ICD-10-CM/PCS. Includes mapping content from ICD-9-CM v1 v2, and v3 codes to ICD-10-CM and -PCS codes (as well as backward mapping) using the GEM (General Equivalency Mappings) and Optum360 MapSelects clinical mapping content. Also includes ICD-10-CM
and -PCS searching and Optum360 tabular (ICD-10-CM and -PCS books) content. ...
$1,495.95 Each
Item # 901-114519
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