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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
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$34.09
Discontinued soon
250/pack
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Suggested replacement  
Save $7.10
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 250 (CMS12LC250)
Price is $26.99
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ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
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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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    Product specifications table
    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 UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5) 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
    ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 250 (CMS12LC250)
    Price is $26.99
    ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)~#|#~BEEB25B0-3006-416D-A7EB845F6AB6205B_sc7
    Price is $29.39
    TOPS Centers for Medicare and Medicaid Services Forms, 8-1/2" x 11" (50135RV)~#|#~s1053550_sc7
    Price is $34.59
    ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 500 (CMS12LC500)
    Price is $48.09
    Reviews
    4.76
    50
    4.42
    26
    No reviews yet
    4.69
    13
    4.74
    34
    Delivery Information
    Next-Day Delivery by tomorrow
    Delivery by Mon, Feb 09
    Delivery by Thu, Feb 12
    Next-Day Delivery by tomorrow
    Free delivery by Mon, Feb 09
    Available in my store
    No
    No
    No
    No
    No
    Length in Inches
    11
    11
    11
    11
    11
    Width in Inches
    8.5
    8.5
    8.5
    8.5
    8.5
    Medical Form Type
    Health Insurance Claims
    Health Insurance Claims
    Health Insurance Claims
    Consent
    Health Insurance Claims
    Medical Form Pack Size
    250
    250
    500
    250
    500
    True Color
    White
    White / Red
    Data not available
    Red and White
    White / Red
    Form Size
    8 1 / 2" x 11"
    Data not available
    Data not available
    8 1 / 2" x 11"
    Data not available
    Print Type
    Laser
    Laser
    Laser
    Continuous
    Laser
    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
    Data not available
    Yes
    Data not available
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