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
250/pack
Free Returns
Online. In store. Always free.
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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
Frequently bought together
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Price is $15.99, Regular price was $19.49, You save 17%
Unit of measure 10/Pack Price per unit $1.60/Correction Tape
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Unit of measure 250/Box Price per unit $0.11/File Folder
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Unit of measure 8/Pack Price per unit $0.06/Pencil
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Price is $16.99, Regular price was $20.59, You save 17%
Unit of measure 100/Box Price per unit $0.17/File Folder
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Staples Block Erasers, Pink, 3/Pack (10433-CC) is In-store only
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Unit of measure 3/Pack Price per unit $0.33/Eraser
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Unit of measure 5/Pack Price per unit $0.40/Highlighter
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Price is $0.50, Regular price was $2.19, You save 77%
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Price is $9.99, Regular price was $12.69, You save 21%
Unit of measure Dozen Price per unit $0.83/Marker
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Price is $6.99, Regular price was $8.69, You save 19%
Unit of measure 60/Pack Price per unit $0.12/Pen
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Over 30
Price is $0.25, Regular price was $0.79, You save 68%
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Price is $15.69
Unit of measure Dozen Price per unit $0.01/Post-it® Note
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Over 30
Price is $16.99, Regular price was $19.59, You save 13%
Unit of measure Dozen Price per unit $1.42/Pad
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Over 30
Price is $6.99, Regular price was $8.19, You save 14%
Unit of measure 4/Pack Price per unit $1.75/Correction Tape
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Price is $9.99
Unit of measure 1000/Pack Price per unit $0.01/Paper Clip
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Over 30
Price is $4.29, Regular price was $7.29, You save 41%
Unit of measure 18/Pack Price per unit $0.24/Pencil
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Price is $0.55, Regular price was $2.49, You save 77%
Price per unit $0.55/Folder
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Price per unit $0.55/Folder
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Price is $8.69
Unit of measure 12/Pack Price per unit $0.72/Binder Clip
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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", Pack of 500 (CMS12LC500) | ComplyRight CMS-1500 Health Insurance Claims, 2500/Pack (CMS12LC) | ComplyRight CMS-1500 Jumbo Health Care Billing Envelope, 500/Pack (1500LR500) |
|---|---|---|---|---|---|
Your product ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250) Price is $33.19 |  Price is $26.29 |  Price is $46.89 |  Price is $89.59 |  Price is $143.09 | |
| Reviews | |||||
| Delivery Information | Next-Day Delivery by tomorrow | Delivery by Thu, Jul 24 | Free delivery by Thu, Jul 24 | Free delivery by Thu, Jul 24 | Free delivery by Thu, Jul 24 |
| Available in my store | No | No | No | No | 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 | 500 | 2500 | 500 |
| Length in Inches | 11 | 11 | 11 | 11 | Data not available |
| Width in Inches | 8.5 | 8.5 | 8.5 | 8.5 | Data not available |
| True Color | White | White / Red | White / Red | White / Red | White / Blue |
| Form Size | 8 1 / 2" x 11" | Data not available | Data not available | 8 1 / 2" x 11" | 9" x 12.5" |
| Print Type | Laser | Laser | Laser | Laser | Data not available |
| Series or Collection | CMS-1500 | Data not available | Data not available | CMS-1500 | CMS-1500 |
| Next Day Delivery | Yes | Data not available | Data not available | Data not available | Data not available |
| Add To Cart | Add To Cart | Add To Cart | Add To Cart |
Featured Products
Price is $26.49
Unit of measure 50/Pack
Delivery by Tue, Jul 22
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Price is $45.79
Unit of measure 50/Pack
Free delivery by Tue, Jul 22
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Price is $45.79
Unit of measure 25/Pack
Free delivery by Tue, Jul 22
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Price is $21.95
Delivery by Fri, Jul 25
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Price is $37.99
Unit of measure 100/Pack
Free delivery by Tue, Jul 22
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Price is $31.09
Unit of measure 50/Pack
Delivery by Tue, Jul 22
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Price is $32.09
Unit of measure 100/Pack
Delivery by Tue, Jul 22
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Price is $45.12, Regular price was $56.40, You save 20%
Unit of measure 25/Pack
Free delivery by Tue, Jul 22
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Price is $21.19
Unit of measure 50/Pack
Delivery by Tue, Jul 22
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Over 30
Price is $37.89
Unit of measure 50/Pack
Free delivery by Tue, Jul 22
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Price is $51.95
Unit of measure 50/Pack
Free delivery by Tue, Jul 22
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Price is $34.49
Unit of measure 50/Pack
Delivery by Tue, Jul 22
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Price is $65.29
Unit of measure 50/Pack
Free delivery by Tue, Jul 22
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Price is $32.09
Unit of measure 50/Pack
Delivery by Tue, Jul 22
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Price is $37.89
Unit of measure 50/Pack
Free delivery by Tue, Jul 22
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