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ComplyRight CMS-1500 Health Insurance Claim Form (02/12), 1000/Carton (CMS12LC1)
Item # : 116719
Model # : CMS12LC1
5 out of 5 stars
32
  • Approved by the National Uniform Claim Committee (NUCC); HIPAA compliant
  • The most significant change was the addition of 8 diagnosis codes in field 21
$24.49
1000/Carton
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ComplyRight CMS-1500 Health Insurance Claims, 250/Box (CMS12LC250)
Item # : 125555
Model # : CMS12LC250
4.5 out of 5 stars
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Meet billing requirements for Medicare part B using these ComplyRight CMS-1500 health insurance claim forms.
  • Satisfy record-keeping requirements with these health insurance claim forms
  • Contains 250 forms per box
$41.49
250/Box
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ComplyRight CMS-1500 Health Insurance Claims, 500/Pack (CMS12LC500)
Item # : 125556
Model # : CMS12LC500
4.5 out of 5 stars
27
Stay in compliance when submitting insurance claims with this 500-pack of ComplyRight CMS-1500 laser-cut health insurance claim forms.
  • Satisfy record-keeping requirements with these health insurance claim forms
  • Contains 500 forms per package
$47.99
500/Pack
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TFP UB-04 CMS-1450 1-Part Health Insurance Claims, 2500/Carton (UB04LC)
Item # : 519727
Model # : UB04LC
4 out of 5 stars
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Complete billing tasks with these TFP UB-04 one-part hospital claim forms.
  • Designed for hospitals to file a medical claim with the patient's insurance carrier
  • One-part health insurance forms
$86.99
2500/Carton
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