NOTICE: As of June 30, 2016 the OMB Number 0938-1197 on the CMS-1500
form dated (02/12) has expired. This is a standard practice within the Government Agency, Office of Management and Budget
(OMB). The agency is currently in the process
of extending the OMB number 0938-1197 with a new date of (09/19) within
internal departments. No changes to the forms fields have been made,
however the date change at the top and bottom of the from has been
updated from (02/12) to (09/19).The Centers for Medicare & Medicaid Services (CMS) approved a new CMS-1500 form (02/12) to replace the previous 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.
· 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
2,500 forms per carton, 1 carton minimum.
Ships UPS ground to the continental U.S. for $9.75/case; most cartons deliver in 24-48 hours.
Interested in a free sample? Click here.