ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
$34.09
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Highlights
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- 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
$34.09
Discontinued soon
250/pack
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Suggested replacement
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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
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Unit of measure 25/Box Price per unit $0.70/Mailer
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Unit of measure 50/Pack Price per unit $0.36/Cup
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Unit of measure 2/Pack Price per unit $5.34/Clipboard
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Compare similar items
| 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 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 1,000 (CMS12LC1) | TOPS Centers for Medicare and Medicaid Services Forms, 8-1/2" x 11", 250/Pack (50135RV) | ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 500 (CMS12LC500) |
|---|---|---|---|---|---|
Your product ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250) Price is $34.09 |  Price is $26.99 |  Price is $85.89 |  Price is $34.59 |  Price is $48.09 | |
| Reviews | |||||
| Delivery Information | Next-Day Delivery by tomorrow | Delivery by Wed, Oct 15 | Free Next-Day eligible by tomorrow | Next-Day Delivery by tomorrow | Free delivery by Wed, Oct 15 |
| Available in my store | No | No | No | No | No |
| Medical Form Type | Health Insurance Claims | Health Insurance Claims | Health Insurance Claims | Consent | Health Insurance Claims |
| Medical Form Pack Size | 250 | 250 | 1000 | 250 | 500 |
| Length in Inches | 11 | 11 | 11 | 11 | 11 |
| Width in Inches | 8.5 | 8.5 | 8.5 | 8.5 | 8.5 |
| True Color | White | White / Red | White / Red | Red and White | White / Red |
| Print Type | Laser | Laser | Laser | Continuous | Laser |
| Form Size | 8 1 / 2" x 11" | Data not available | Data not available | 8 1 / 2" x 11" | Data not available |
| Series or Collection | CMS-1500 | Data not available | Data not available | Centers for Medicare and Medicaid Services | Data not available |
| Next Day Delivery | Yes | Data not available | Yes | Yes | Data not available |
| Add To Cart | Add To Cart | Add To Cart | Add To Cart |
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Unit of measure 50/Pack
Free delivery by Fri, Oct 17
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Unit of measure 50/Pack
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Unit of measure 50/Pack
Free delivery by Tue, Oct 14
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Unit of measure 100/Pack
Free delivery by Tue, Oct 14
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Unit of measure 50/Pack
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Price is $59.59
Free delivery by Fri, Oct 17
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Price is $57.29
Unit of measure 50/Pack
Free delivery by Tue, Oct 14
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Price is $57.29
Free delivery by Fri, Oct 17
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