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8-1/2" x11" CMS HCFA 1500, Laser Fromat

8-1/2" x11" CMS HCFA 1500, Laser Fromat


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8-1/2" x11"
CMS 1500
1 Part
for Laser / Ink Jet

Availability: In stock

Paper Size: 8-1/2 x11"
Parts: 1
Qty. Per Carton: 2500 (5 Packs of 500)
Type: Laser
Paper Weight: 20# for laser
Color: White
Qty. Per Pack: 500

Product Attachments

View FileCM44    Size: (224.02 KB)
Description about the product

• Required for any health-care provider in order to bill a insurance co. for reimbursement of a medical claim.

• CMS-1500 (version 02/12) replaced the old version 08/05

• The form must have accurate content and conform to the Health Insurance Portability and Accountability Act (HIPAA).  Developed in conjunction with all the governing agencies, including the National Uniform Claim Committee (NUCC), the National Uniform Billing Committee (NUBC), the CMS Centers for Medicare and Medicaid Services, the Health and Human Services Agency, and the American Hospital Association.

• Laser format 20-lb paper with OCR "dropout" red ink for greater scanning accuracy. 

• SFI Certified — Certified to meet SFI standards.

For the Continuous CMS 1500 click here 

Q) Why was the 1500 Claim Form changed?

A) The form was been changed to align the paper form with some of the changes in the electronic Health Care Claims: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1). 


Q) What is the latest revision?

A) The most recent form is “Revision 02/12.”


Q) What are the specific changes that were made to the form?

A) The most significant changes were the addition of eight diagnosis codes in Item Number 21 and the addition of the QR Code at the top left of the form. no more barcode on the top left, For a complete list of the changes from the current (08/05) version to the revised (02/12), view the Change Log Document (PDF)

[link to] posted on the NUCC website. 


Q) Why was the QR Code added to the top of the form?

A) The QR Code includes a link to an NUCC landing page to provide information about this hcfa form. It also helps align the form for the reader. 


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