Medical Forms*ComplyRight ™ CMS-1500 Health Insurance Claim Form (02/12); 1-Part Continuous, 1,000/Carton

$31.99

SKU: SKU116713 Categories: Forms, Medical Forms, Paper Tag: ComplyRight Brand: ComplyRight

Description
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Approved by the National Uniform Claim Committee (NUCC) and is HIPAA compliant.

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″
1,000 per carton

Specifications table
Attribute name	Attribute value
Length in Inches Items of a particular grouping, as merchandised and labeled by a manufacturer	CMS-1500
Pack Qty	1
Form Size The overall width of the product, measured left to right.	8.5
Medical Form Type	Continuous
Medical Form Pack Size	1000