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
Final price is $34.09
Discontinued soon
250/pack
Free Returns
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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 $38.89
Unit of measure 750/Pack Price per unit $0.05/Label
Free delivery by Tue, Apr 07
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Price is $16.19
Unit of measure 40/Pack
Delivery by Tue, Apr 14
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Price is $242.09
Unit of measure Box
Free delivery by Wed, Apr 08
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Price is $14.29
Unit of measure 50/Pack
Delivery by Wed, Apr 15
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Price is $8.09
Unit of measure 2/Pack Price per unit $0.50/Fl Oz
Delivery by Tue, Apr 07
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Price is $82.99
Free delivery by Tue, Apr 14
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Price is $127.99
Unit of measure 500/Box
Free delivery by Tue, Apr 14
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Price is $26.19
Unit of measure 50/Pack
Delivery by Mon, Apr 13
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Price is $17.99
Delivery by Tue, Apr 07
30-min pickup
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Price is $43.29
Unit of measure 12/Pack Price per unit $3.61/Pad
Free delivery by Tue, Apr 07
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Price is $26.09
Unit of measure 50/Pack
Delivery by Wed, Apr 15
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Pilot G2 SmileyWorld Retractable Gel Pen, Fine Point, 0.7mm, Black Ink, 5 Pens/Pack (G2HC5BLKF) is New at Staples
Price is $9.99
Delivery by Tue, Apr 07
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Price is $24.99
Unit of measure Dozen Price per unit $2.08/Pen
Delivery by Tue, Apr 07
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Price is $26.99
Unit of measure 100/Box
Delivery by Tue, Apr 07
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Price is $19.49
Delivery by Tue, Apr 07
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Price is $104.99
Unit of measure 500/Box Price per unit $0.21/Envelope
Free delivery by Tue, Apr 07
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Price is $22.99
Unit of measure 6/Pack Price per unit $3.83/Pen
Delivery by Tue, Apr 07
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Price is $211.39
Unit of measure 50/Carton Price per unit $4.23/Roll
Free delivery by Tue, Apr 07
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Price is $45.99
Unit of measure 250/Box Price per unit $0.18/Envelope
Free delivery by Tue, Apr 07
30-min pickup
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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", Box of 1,000 (CMS12LC1) | ComplyRight CMS-1500 Health Insurance Claims, 2500/Pack (CMS12LC) | 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 |  Price is $27.69 |  Price is $85.89 |  Price is $91.89 |  Price is $48.09 | |
| Reviews | |||||
| Delivery Information | Delivery by Tue, Apr 07 | Delivery by Tue, Apr 14 | Free delivery by Tue, Apr 07 | Free delivery by Tue, Apr 14 | Free delivery by Tue, Apr 14 |
| 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 | Health Insurance Claims | Health Insurance Claims |
| Medical Form Pack Size | 250 | 250 | 1000 | 2500 | 500 |
| True Color | White | White / Red | White / Red | White / Red | White / Red |
| Form Size | 8 1 / 2" x 11" | Data not available | Data not available | 8 1 / 2" x 11" | Data not available |
| Series or Collection | CMS-1500 | Data not available | Data not available | CMS-1500 | Data not available |
| Print Type | Laser | Laser | Laser | Laser | Laser |
| Next Day Delivery | Yes | Data not available | Yes | Data not available | Data not available |
| Add To Cart | Add To Cart | Add To Cart | Add To Cart |
