8-1/2" x 11" 1-Part Continuous Health Insurance Claim Form (HCFA) with Blown-on Self-Imaging Labels (02/12 Version): Item HIC1500C
The most widely used business form in America!
- Per federal regulations, all healthcare providers must use the CMS-1500 Form for specific types of billing.
- Forms are 100% fully compliant and rejection-proof, to ensure quicker payment by insurance companies.
- Accommodates reporting of the National Provider Identifier (NPI), which must be used by all HIPAA-covered entities.
- Conforms to the HIPAA - Health Insurance Portability and Accountability Act.
- Officially approved by the CMS Centers for Medicare and Medicaid Services, National Uniform Claim Committee (NUCC), National Uniform Billing Committee (NUBC), American Hospital Association (AHA), and the Health and Human Services Agency.
- QR Code located top left hand side of the form. The QR Code links to a NUCC landing page that provides information about the form. It also helps to align the form for the reader.
- Uses soy-based OCR "dropout" red ink and SFI (Sustainable Forestry Initiative) 20# paper for greater scanning accuracy.
- Twelve lines to list diagnosis code(s) for the nature of illness/injury.
- Pressure-sensitive label in the upper right-hand corner, which serves as a mailing label addressed to the insurance carrier. The carrier's name and address will remain on the form even after the label has been removed.
- 1,000 forms per case.
- 1 Part.
- Size: 8-1/2" x 11"