100 Economy Pack - Form CMS-1500

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100 Economy Pack - Form CMS-1500

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$10.99 $8.90

Product Information

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. Economical 100 pack.

  • Approved by the National Uniform Claim Committee (NUCC)
  • HIPAA compliant
  • Printed with OCR "dropout" red ink on 20lb. paper (per government regulations)
  • Certified Chain of Custody
  • Promotes sustainable forest management


Product Code CMS1500A
Manufacturer Diversified
Condition New
Weight 1lb

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