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CMS 1500 Claim Form Version 02/12

These are the CMS 1500 Claimforms 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.

The transition period for switching to the new form has passed. As of April 1st, 2014, the old claim form (08/05) was discontinued and all private insurance carriers and Medicare began receiving and processing paper claims submitted only on the revised CMS-1500 claim form (02/12).

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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