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New 2014 CMS 1500 Claim Form

These are the NEW 2014 CMS 1500 Claim forms  version 02/12 for laser or inkjet printers, available to purchase alone or in bundles.

The Centers for Medicare & Medicaid Services approved a new CMS-1500 form (02/12) to replace the previous CMS form (08/05). Fully updated with the latest revisions, the new CMS 1500 form is 100% compliant and printed to exact specifications for layout, paper and ink.
Both CMS and the NUCC have issued their transition timelines, affecting providers that accept government and private insurance.  The final transition timeline for implementation of the revised CMS-1500 claim form is as follows:
January 6, 2014: Private insurance carriers and Medicare begin receiving and processing paper claims on the revised CMS-1500 claim form (02/12)
January 6 - March 31, 2014: Dual-use period during which private insurance carriers and Medicare continue to receive and process paper
claims submitted on either version of the form
April 1, 2014: The current claim form (08/05) is discontinued; all private
insurance carriers and Medicare receives and processes paper claims
submitted only on the revised CMS-1500 claim form (02/12)
Providers will need to check with their payer and/or clearinghouses to determine when they will begin to accept the revised CMS forms.
  • Designed for laser printers or inkjet printers, can also be handwritten
  • Uses soy-based black and OCR “dropout” red ink for greater scanning accuracy
  • Printed on SFI (Sustainable Forestry Initiative) paper·       
  • Features Anti-Rejection Projection™* -- guaranteed acceptance by insurance carriers for rejection-proof claim filing and quicker payment

Quick Facts About Our New CMS 1500 Forms 
  • 24 Hour Turnaround 
  • Instant Online Pricing 
  • UPS Ground To Most States In 3 Days Or Less 
  • Discounts For More Than 1 Carton Purchases (or Pack) 
  • 100% compliant with the approved update to the HCFA 1500 health claim form 
  • Contains Approved OMB-0938-1197 FORM CMS 1500 (02/12) on the bottom of the form 
  • The arrow at the top right of the form measures 1/4" from the top of the form, as required 
  • Approved by the NUCC

*If a CMS-1500 form is rejected by an insurance carrier due to improper formatting or print quality, we will provide a full replacement order of the purchaser’s forms. To qualify, you must notify us no later than 20 days after the rejection letter is issued. Upon review of the rejection letter and confirmation that the rejected forms were manufactured by us, we will send a full replacement order of the affected items. This Anti-Rejection Protection™ limited warranty applies to rejections based on the form itself being invalid due to ink quality or formatting, such as data elements being improperly positioned or misaligned. This protection does not apply to missing or incorrect entries provided by the user.

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