ComplyRight® CMS-1500 Health Insurance Claim Form

Meet billing requirements for Medicare Part B. Easy-to-read forms with crisp, clean text help ensure faster claims processing. Paper, layout and ink comply with CMS standards and requirements. Layout includes all 02/12 NUCC revisions. Printed in scannable, OCR "dropout" red ink.

Manufacturer: TFP DATA SYSTEMS

Meet billing requirements for Medicare Part B.
Easy-to-read forms for faster claims processing.
Comply with CMS standards and requirements for paper, layout and ink.
Printed in scannable, dropout OCR red ink.
Include all 02/12 NUCC revisions, replacing the previous 08/05 version.

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Meet billing requirements for Medicare Part B.
Easy-to-read forms for faster claims processing.
Comply with CMS standards and requirements for paper, layout and ink.
Printed in scannable, dropout OCR red ink.
Include all 02/12 NUCC revisions, replacing the previous 08/05 version.

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CMS-1500 Health Insurance Claim Form, One-Part (No Copies), 8.5 x 11, 1,000 Forms Total1

CMS-1500 Health Insurance Claim Form, One-Part (No Copies), 8.5 x 11, 1,000 Forms Total

SKU: TFPCMS12LC1

Manufacturer part number: CMS12LC1

Vendor: Essendant

MSRP: $76.95

Price: $46.80

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