ComplyRight™ CMS-1500 Health Insurance Claim Form 02/12 Laser-Cut Sheet, 500/Box
Original price was: $26.00.$18.89Current price is: $18.89.
Ensure all the necessary information for insurance claims is submitted by using these laser-cut health insurance claim forms. The red printed ink lets writing stand out, making these forms easy to read, while the 20-pound weight gives each sheet a sturdy feel. With 500 sheets in each pack, these ComplyRight health insurance claim forms are easy to keep in stock.
- 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 health care 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″
- 500 per box
| Attribute name | Attribute value |
|---|---|
| Medical Form Pack Size | 11 |
| Series or Collection The physical dimensions of the form. | 8 1/2″ x 11″ |
| Width in Inches | Health Insurance Claims |
| Print Type | Laser |
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