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