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New CMS-1500 (HCFA) Form Version 02/12, 2-Part, (White/Canary), for Pinfeed Printers w/ Label

New CMS-1500 (HCFA) Form Version 02/12, 2-Part, (White/Canary), for Pinfeed Printers w/ Label
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Name: New CMS-1500 (HCFA) Form Version 02/12, 2-Part, (White/Canary), for Pinfeed Printers w/ Label
Your Price:
As low as $35.00
Serial Number: L0295



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 their 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.

 


 

·      Form contains pressure sensitive blown on label in upper right corner

·      2-part carbonless -- Top sheet color is white, second sheet color is

        canary

·       Uses soy-based black and OCR "dropout” red ink for greater scanning

        accuracy

·       Printed on SFI (Sustainable Forestry Initiative) paper

·       Continuous format designed for pinfeed printers

·       Features Anti-Rejection Projection™* -- guaranteed acceptance by

        insurance carriers for rejection-proof claim filing and quicker payment

 

1,000 forms per carton, 1 carton minimum.

Ships in 24 hours; expedited shipping available.

 

Interested in a free sample? Click here.

Bulk Pricing:
Min Qty Price Per Unit
1 $38.00
5 $36.00
10 $35.00
Quantity To Order:
 

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*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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