ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
$34.09
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
$34.09
Discontinued soon
250/pack
Free Returns
Online. In store. Always free.
Learn More
1
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
Add to list
Suggested replacement
Save $6.40
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
Frequently bought together
Page 1 of 4
Price is $26.19
Unit of measure 100/Pack
Delivery by Fri, May 01
1
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
Add to list
Price is $17.19
Delivery by Tue, Apr 28
1
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
Add to list
Price is $56.99
Free delivery by Thu, Apr 30
1
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
Add to list
Price is $16.19
Unit of measure 40/Pack
Delivery by Tue, May 05
1
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
Add to list
Price is $38.89
Unit of measure 750/Pack Price per unit $0.05/Label
Free delivery by Tue, Apr 28
1
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
Add to list
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) | Adams CMS-1500 Health Insurance Claims, 100/Pack (CMS1500L1V) | ComplyRight CMS-1500 Health Insurance Claims, 2500/Pack (CMS12LC) |
|---|---|---|---|---|---|
Your product ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250) Price is $34.09 |  Price is $27.69 |  Price is $85.89 |  Price is $24.79 |  Price is $91.89 | |
| Reviews | |||||
| Delivery Information | Delivery by Tue, Apr 28 | Delivery by Mon, May 04 | Free delivery by Tue, Apr 28 | Delivery by Tue, Apr 28 | Free delivery by Mon, May 04 |
| Available in my store | No | No | No | Yes | No |
| Medical Form Type | Health Insurance Claims | Health Insurance Claims | Health Insurance Claims | Health Insurance Claims | Health Insurance Claims |
| Medical Form Pack Size | 250 | 250 | 1000 | 100 | 2500 |
| 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 | White / Red | White / Red |
| Print Type | Laser | Laser | Laser | Data not available | Laser |
| Form Size | 8 1 / 2" x 11" | Data not available | Data not available | 8 1 / 2" x 11" | 8 1 / 2" x 11" |
| Series or Collection | CMS-1500 | Data not available | Data not available | CMS-1500 | CMS-1500 |
| Next Day Delivery | Yes | Data not available | Yes | Yes | Data not available |
| Add To Cart | Add To Cart | Add To Cart | Add To Cart |
Featured Products
Page 1 of 3
Price is $65.39
Unit of measure 500/Ream
Free delivery by Fri, May 01
1
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
Add to list
Price is $44.79
Unit of measure 50/Pack
Free delivery by Fri, May 01
1
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
Add to list
Price is $58.59
Unit of measure 50/Pack
Free delivery by Fri, May 01
1
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
Add to list
Price is $37.79
Unit of measure 25/Pack
Free delivery by Fri, May 01
1
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
Add to list
Price is $32.09
Unit of measure 100/Pack
Delivery by Fri, May 01
1
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
Add to list
