Highlights
  • 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

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

Item #: 953631Model #: CMS12LC500
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500/pack
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About this product

Stay in compliance when submitting insurance claims with this 500-pack of ComplyRight CMS-1500 laser-cut health insurance claim forms.

Ensure all the necessary information for insurance claims is submitted by using these laser-cut health insurance claim forms. The red printed ink lets writing stand out, making these forms easy to read, while the 20-pound weight gives each sheet a sturdy feel. With 500 sheets in each pack, these ComplyRight health insurance claim forms are easy to keep in stock.

  • 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
  • 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)
  • Form not available personalized
  • Certified Chain of Custody; promotes sustainable forest management
  • Size: 8-1/2 x 11"
  • 500 per box