https://www.staples-3p.com/s7/is/image/Staples/s0916795_sc7
ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
$34.09
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Product image 1
Highlights
View all details
  • 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

ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)

Item #: 953639Model #: CMS12LC250
1 Question
$34.09
Discontinued soon
250/pack
Order within 10 hrs 17 mins

Free Returns

Online. In store. Always free.

Learn More

Extra 10% off your purchase with the Staples app. This week only. Download app
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Suggested replacement  
Save $6.40
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 250 (CMS12LC250)
Price is $27.69
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Customers bought together
ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250) is Your Product
Price is $34.09
Pendaflex Recycled End Tab File Folder, Straight Cut, Letter Size, Manila, 100/Box (H110EE)~#|#~m002275547_sc7
Price is $48.99
Medical Arts Press® Jeter® Compatible Alpha Sheet Style Labels, "C"~#|#~m002247078_sc7
Price is $4.91
Staples 2-Pocket Paper Folder, Gray – Letter Size School & Office Folder for Documents and Reports~#|#~9C3EF1FE-31F9-4FC9-897BFAD515A4563A_sc7
Price is $15.39
Price for all 4
$103.38

    • About this product

    Meet billing requirements for Medicare part B using these ComplyRight CMS-1500 health insurance claim forms.

    Use these easy-to-read insurance claim forms for a faster claims process. Printed in scannable, dropout OCR red ink, these documents deliver crisp, clean text and comply with CMS standards and requirements for paper, layout and ink to expedite the receipt of payment for health care facilities. These ComplyRight CMS-1500 forms include 02/12 NUCC revisions and replace the previous 08/05 version.

    • 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
    • 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"
    • Laser-cut sheet
    • 250 per box

    Compare similar items

    Product specifications table
    Attributes ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250) ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 250 (CMS12LC250) ComplyRight CMS-1500 Jumbo Health Care Billing Envelope, 500/Pack (1500LR500) TOPS CMS-1500 Health Insurance Claims, 500/Pack (TOP 50126RV) TOPS Centers for Medicare and Medicaid Services Forms, 8-1/2" x 11", 250/Pack (50135RV)
    Your product
    ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
    Price is $34.09
    ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 250 (CMS12LC250)
    Price is $27.69
    ComplyRight CMS-1500 Jumbo Health Care Billing Envelope, 500/Pack (1500LR500)~#|#~CB10C34C-990A-4982-AA7ADEE633A9E839_sc7
    Price is $146.69
    TOPS CMS-1500 Health Insurance Claims, 500/Pack (TOP 50126RV)~#|#~43D41C18-579A-4B95-856C2FF6A9BDA1E7_sc7
    Price is $51.89
    TOPS Centers for Medicare and Medicaid Services Forms, 8-1/2" x 11" (50135RV)~#|#~s1053550_sc7
    Price is $34.59
    Reviews
    4.76
    51
    4.33
    27
    5
    1
    4.92
    12
    4.71
    14
    Delivery Information
    Next-Day Delivery by tomorrow
    Delivery by Thu, Jul 23
    Free delivery by Thu, Jul 23
    Free Next-Day eligible by tomorrow
    Next-Day Delivery by tomorrow
    Available in my store
    No
    No
    No
    No
    No
    Width in Inches
    8.5
    8.5
    Data not available
    8.5
    8.5
    Medical Form Type
    Health Insurance Claims
    Health Insurance Claims
    Health Insurance Claims
    Health Insurance Claims
    Consent
    Medical Form Pack Size
    250
    250
    500
    500
    250
    Length in Inches
    11
    11
    Data not available
    11
    11
    True Color
    White
    White / Red
    White / Blue
    White / Red
    Red and White
    Form Size
    8 1 / 2" x 11"
    Data not available
    9" x 12.5"
    8 1 / 2" x 11"
    8 1 / 2" x 11"
    Print Type
    Laser
    Laser
    Data not available
    Laser
    Continuous
    Series or Collection
    CMS-1500
    Data not available
    CMS-1500
    CMS-1500
    Centers for Medicare and Medicaid Services
    Next Day Delivery
    Yes
    Data not available
    Data not available
    Yes
    Yes
    Price Per Unit
    Data not available
    Data not available
    Data not available
    Data not available
    Data not available
    Add To Cart
    Add To Cart
    Add To Cart
    Add To Cart
    featuredProductsCarouselImage
    featuredProductsCarouselImage