8-1/2" x 11" 2-Part Carbonless Snap Set Health Insurance Claim Form (HCFA) (02/12 Version): Item HIC1500S

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.
  • 500 forms per case.
  • Carbonless.
  • 2 Part, Snap set.
  • Size: 8-1/2" x 11"

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Picture of 8-1/2" x 11" 2-Part Carbonless Snap Set Health Insurance Claim Form (HCFA) (02/12 Version) Picture of 8-1/2" x 11" 2-Part Carbonless Snap Set Health Insurance Claim Form (HCFA) (02/12 Version)