ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
$33.19
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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
$33.19
Discontinued soon
250/pack
Free Returns
Online. In store. Always free.
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Suggested replacement
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
Price is $28.59
Delivery by Thu, Sep 11
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Over 30
Price is $15.89
Delivery by Tue, Sep 02
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Over 30
Price is $49.89
Unit of measure 100/Box
Free delivery by Mon, Sep 08
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Price is $25.39
Unit of measure 250/Box
Delivery by Fri, Sep 05
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Over 30
Price is $53.69
Unit of measure 75/Box
Free delivery by Thu, Sep 04
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Over 30
Price is $51.99
Free delivery by Tue, Sep 02
30-min pickup
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Over 30
Price is $42.49
Free delivery by Tue, Sep 02
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Over 30
Price is $62.19
Unit of measure 43/Box
Free delivery by Fri, Sep 05
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Price is $34.19
Unit of measure 100/Box
Delivery by Tue, Sep 02
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Over 30
Price is $15.89
Price per unit $0.64/Wipe
Delivery by Wed, Sep 03
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Over 30
Price is $193.99, Regular price was $378.29, You save 48%
Free delivery by Tue, Sep 02
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Over 30
Price is $35.39
Unit of measure 100/Box
Free delivery by Tue, Sep 02
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Price is $17.19
Unit of measure 25/Box Price per unit $0.69/Mailer
Delivery by Tue, Sep 02
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Over 30
Price is $9.99, Regular price was $10.99, You save 9%
Unit of measure Dozen Price per unit $0.83/Marker
Delivery by Tue, Sep 02
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Price is $17.39
Unit of measure 50/Pack Price per unit $0.35/Cup
Delivery by Tue, Sep 02
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Over 30
Price is $26.59
Delivery by Tue, Sep 02
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Over 30
Price is $39.19
Price per unit $0.31/FL Oz
Free delivery by Tue, Sep 02
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Over 30
Price is $6.69
Unit of measure 2/Pack Price per unit $3.34/Refill
Delivery by Tue, Sep 02
30-min pickup
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Price is $16.99
Delivery by Tue, Sep 02
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Price is $36.49
Free delivery by Tue, Sep 02
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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) | 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) | ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 1,000 (CMS12LC1) |
|---|---|---|---|---|---|
Your product ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250) Price is $33.19 |  Price is $26.29 |  Price is $33.69 |  Price is $46.89 |  Price is $83.79 | |
| Reviews | |||||
| Delivery Information | Delivery by Tue, Sep 02 | Delivery by Mon, Sep 08 | Delivery by Tue, Sep 02 | Free delivery by Mon, Sep 08 | Free delivery by Tue, Sep 02 |
| Available in my store | No | No | No | No | No |
| Medical Form Type | Health Insurance Claims | Health Insurance Claims | Consent | Health Insurance Claims | Health Insurance Claims |
| Medical Form Pack Size | 250 | 250 | 250 | 500 | 1000 |
| 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 | Red and White | White / Red | White / Red |
| Print Type | Laser | Laser | Continuous | Laser | Laser |
| Form Size | 8 1 / 2" x 11" | Data not available | 8 1 / 2" x 11" | Data not available | Data not available |
| Series or Collection | CMS-1500 | Data not available | Centers for Medicare and Medicaid Services | Data not available | Data not available |
| Next Day Delivery | Yes | Data not available | Yes | Data not available | Yes |
| Add To Cart | Add To Cart | Add To Cart | Add To Cart |
Featured Products
Price is $79.69
Unit of measure 500/Box
Free delivery by Fri, Sep 05
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Over 30
Price is $49.59
Unit of measure 250/Box
Free delivery by Fri, Sep 05
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Price is $26.49
Unit of measure 50/Pack
Delivery by Fri, Sep 05
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Price is $16.79
Unit of measure 100/Pack
Delivery by Fri, Sep 05
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Over 30
Price is $56.19
Free delivery by Wed, Sep 10
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Over 30
Price is $57.29
Free delivery by Wed, Sep 10
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Over 30
Price is $33.29
Delivery by Wed, Sep 10
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Price is $19.59
Delivery by Wed, Sep 10
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Price is $15.59
Unit of measure 50/Pack
Delivery by Fri, Sep 05
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Over 30
Price is $52.19
Unit of measure 50/Pack
Free delivery by Wed, Sep 10
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Over 30
Price is $29.29
Delivery by Wed, Sep 10
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Over 30
Price is $17.39
Unit of measure 50/Pack
Delivery by Fri, Sep 05
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Over 30
Price is $166.39
Free delivery by Wed, Sep 10
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Over 30
Price is $45.79
Unit of measure 50/Pack
Free delivery by Fri, Sep 05
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Over 30
Price is $31.09
Unit of measure 50/Pack
Delivery by Fri, Sep 05
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