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ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
$32.09
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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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250/pack

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Only $9.89 Staples Smooth Paper Clips, 1000/pack. Add to cart.
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ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 250 (CMS12LC250)
Price is $25.39
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ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250) is Your Product
Price is $32.09
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$200.57
    • Details

    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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    Specifications
    Specifications table
    Attribute nameAttribute value
    Length in Inches 11
    Series or Collection
    		CMS-1500
    Form Size
    		8 1/2" x 11"
    Width in Inches
    		8.5
    Medical Form Type Health Insurance Claims
    Print Type Laser
    Medical Form Pack Size 250
    Next Day Delivery Yes
    True Color
    		White
    Reviews

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    ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
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    Price is $86.59
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    Reviews
    4.8
    19
    4.6
    25
    4.7
    67
    4.7
    13
    4.8
    57
    4.7
    31
    4.9
    42
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    4.9
    12
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    Delivery Information
    Delivery by Tue, May 06
    Delivery by Tue, May 13
    Delivery by Tue, May 06
    Delivery by Tue, May 06
    Free delivery by Tue, May 13
    Free delivery by Tue, May 13
    Free delivery by Tue, May 06
    Free delivery by Tue, May 13
    Free delivery by Tue, May 06
    Free delivery by Tue, May 13
    Free delivery by Tue, May 13
    Delivery by Tue, May 13
    Available in my store
    No
    No
    Yes
    No
    No
    No
    No
    No
    No
    No
    No
    No
    Medical Form Type
    Health Insurance Claims
    Health Insurance Claims
    Health Insurance Claims
    Consent
    Health Insurance Claims
    Health Insurance Claims
    Health Insurance Claims
    Health Insurance Claims
    Health Insurance Claims
    Dental Claims
    Dental Claims
    Dental Claims
    Medical Form Pack Size
    250
    250
    100
    250
    2500
    500
    1000
    500
    500
    500
    2500
    100
    True Color
    White
    White / Red
    White / Red
    Red and White
    White / Red
    White / Red
    White / Red
    White / Blue
    White / Red
    White
    White
    White
    Length in Inches
    11
    11
    11
    11
    11
    11
    11
    Data not available
    11
    11
    11
    11
    Width in Inches
    8.5
    8.5
    8.5
    8.5
    8.5
    8.5
    8.5
    Data not available
    8.5
    8.5
    8.5
    8.5
    Print Type
    Laser
    Laser
    Data not available
    Continuous
    Laser
    Laser
    Laser
    Data not available
    Laser
    Laser
    Laser
    Laser
    Form Size
    8 1 / 2" x 11"
    Data not available
    8 1 / 2" x 11"
    8 1 / 2" x 11"
    8 1 / 2" x 11"
    Data not available
    Data not available
    9" x 12.5"
    8 1 / 2" x 11"
    8-1 / 2" x 11"
    8-1 / 2" x 11"
    8-1 / 2" X 11"
    Series or Collection
    CMS-1500
    Data not available
    CMS-1500
    Centers for Medicare and Medicaid Services
    CMS-1500
    Data not available
    Data not available
    CMS-1500
    CMS-1500
    Data not available
    Data not available
    Data not available
    Next Day Delivery
    Yes
    Data not available
    Yes
    Data not available
    Data not available
    Data not available
    Yes
    Data not available
    Data not available
    Data not available
    Data not available
    Data not available
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