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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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 500/Box Price per unit $0.06/Envelope
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Compare similar items
| Attributes | ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250) | TOPS CMS-1500 Health Insurance Claims, 500/Pack (TOP 50126RV) | Adams CMS-1500 Health Insurance Claims, 100/Pack (CMS1500L1V) | ComplyRight CMS-1500 Jumbo Health Care Billing Envelope, 500/Pack (1500LR500) | 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 |  Price is $51.89 |  Price is $24.79 |  Price is $146.69 |  Price is $34.59 | |
| Reviews | |||||
| Delivery Information | Delivery by Thu, Sep 17 | Free delivery by Thu, Sep 17 | Delivery by Thu, Sep 17 | Free delivery by Tue, Sep 22 | Delivery by Thu, Sep 17 |
| Available in my store | No | No | Yes | No | No |
| Medical Form Type | Health Insurance Claims | Health Insurance Claims | Health Insurance Claims | Health Insurance Claims | Consent |
| Medical Form Pack Size | 250 | 500 | 100 | 500 | 250 |
| Length in Inches | 11 | 11 | 11 | Data not available | 11 |
| Width in Inches | 8.5 | 8.5 | 8.5 | Data not available | 8.5 |
| True Color | White | White / Red | White / Red | White / Blue | Red and White |
| Print Type | Laser | Laser | Data not available | Data not available | Continuous |
| Form Size | 8 1 / 2" x 11" | 8 1 / 2" x 11" | 8 1 / 2" x 11" | 9" x 12.5" | 8 1 / 2" x 11" |
| Series or Collection | CMS-1500 | CMS-1500 | CMS-1500 | CMS-1500 | Centers for Medicare and Medicaid Services |
| Next Day Delivery | Yes | Yes | Yes | Data not available | Yes |
| Add To Cart | Add To Cart | Add To Cart | Add To Cart |
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