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1500 claim forms

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ComplyRight CMS-1500 Health Insurance Claim Form (02/12), 1000/Carton (CMS12LC1)

ComplyRight CMS-1500 Health Insurance Claim Form (02/12), 1000/Carton (CMS12LC1)

Approved by the National Uniform Claim Committee (NUCC); HIPAA compliant
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
$49.99 Carton
This item ships FREE *
Item # 901-CMS12LC1
Model # CMS12LC1
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
$14.59 Box
This item ships FREE *
Item # 901-CMS12LC250
Model # CMS12LC250
Item # 901-125542
Model # CMS121
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
$24.29 Pack
This item ships FREE *
Item # 901-2408453
Model # 50135RV
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 100 Sheets

ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 100 Sheets

Designed for filing Medicare part B claims as well as claims to commercial insurance companies
Includes the newest NUCC revisions
Printed in red, scannable, OCR ink
$6.99 Pack
This item ships FREE *
Item # 901-CMS12650657
Model # 650657
TFP CMS-1500 Claim Form Envelopes, 4-1/2 x 9-1/2 (1500E)
$30.99 Box
When you buy 10+
or
This item ships FREE *
Item # 901-1500EQ
Model # 1500E
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
$82.99 Carton
When you buy 2+
or
This item ships FREE *
Item # 901-CMS121B
Model # CMS121B
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+
or
This item ships FREE *
Item # 901-CMS122B
Model # CMS122B
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
$49.99 Carton
When you buy 2+
or
This item ships FREE *
Item # 901-CMS1211
Model # CMS1211
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+
or
This item ships FREE *
Item # 901-CMS12W2
Model # CMS12W2
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12), 2-Part Continuous, White/Yellow, 1,000/Bo
$77.99 Box
When you buy 10+
or
This item ships FREE *
Item # 901-CMS122
Model # CMS122
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
This item ships FREE *
Item # 901-CMS123
Model # CMS123
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
$57.99 Pack
This item ships FREE *
Item # 901-309934
Model # 50126RV
ComplyRight CMS-1500 Health Insurance Claim Form (02/12), 3-Part Continuous, White/Canary/Pink, 1000

ComplyRight CMS-1500 Health Insurance Claim Form (02/12), 3-Part Continuous, White/Canary/Pink, 1000/Pack (CMS1239)

Corresponding envelopes sold separately
Accommodates reporting of the National Provider Identifier, which must be used by all HIPAA-covered entities
20-lb paper with OCR "dropout" red ink for greater scanning accuracy
$84.99 Each
This item ships FREE *
Item # 901-1949160
Model # CMS1239
TFP Self Seal Security Tinted Window Envelope, 9 x 12 1/2, White, 100/Pack (1500LR)

TFP Self Seal Security Tinted Window Envelope, 9" x 12 1/2", White, 100/Pack (1500LR)

Self seal CMS-1500 jumbo envelope, right window position
HIPAA security tent, 24 lbs. bond paper
Accomodates 50 unfolded CMS-1500 claim forms
$29.99 Pack
When you buy 10+
or
This item ships FREE *
Item # 901-1500LRQQ
Model # 1500LR
Medical Arts Press Self Seal Window Envelope, 4 1/2 x 9 1/2, White, 500/Box (1500ES)

Medical Arts Press Self Seal Window Envelope, 4 1/2" x 9 1/2", White, 500/Box (1500ES)

Specially designed window envelopes fit CMS 1500 claim forms when tri-folded
All envelopes have confidential lining for added security
Compatible with laser printers
$38.99 Box
When you buy 3+
or
This item ships FREE *
Item # 901-1500ESMAP
Model # 1500ES
Lifetime Warranty
TFP Self Seal Security Tinted Window Envelope, 4 1/2 x 9 1/2, White, 500/Box (1500ES)

TFP Self Seal Security Tinted Window Envelope, 4 1/2" x 9 1/2", White, 500/Box (1500ES)

Self seal CMS-1500 right window envelope
HIPAA security tent, 24 lb. bond paper
Accommodates 12 folded CMS-1500 claim forms
$51.99 Box
When you buy 10+
or
This item ships FREE *
Item # 901-1500ESQ
Model # 1500ES
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. ...
$1,495.99 Each
This item ships FREE *
Item # 901-114519
Model # 1145
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 2-Part Snap-Apart, Carbonless, 500/Box
Out of Stock

ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 2-Part Snap-Apart, Carbonless, 500/Box

Approved by the National Uniform Claim Committee (NUCC); HIPAA compliant
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)
$56.99 Box
Out of Stock
This item is currently unavailable.
Item # 901-CMS12650656
Model # 650656
Out of Stock
This item is currently unavailable.
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 1-Part Continuous, 1,500/Box
Out of Stock

ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 1-Part Continuous, 1,500/Box

Designed for filing Medicare part B claims as well as claims to commercial insurance companies
Includes the newest NUCC revisions
Printed in red, OCR scannable ink in complaince with government standards
$64.99 Box
Out of Stock
This item is currently unavailable.
Item # 901-CMS12651183
Model # 651183
Out of Stock
This item is currently unavailable.
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); Laser-Cut Sheet, 500/Box
Out of Stock
$30.99 Pack
Out of Stock
This item is currently unavailable.
Item # 901-CMS12LC500
Model # CMS12LC500
Out of Stock
This item is currently unavailable.

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