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New CMS-1500 (HCFA) Form Version 02/12, 3-Part, for Pinfeed Printers

New CMS-1500 (HCFA) Form Version 02/12, 3-Part, for Pinfeed Printers
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Name: New CMS-1500 (HCFA) Form Version 02/12, 3-Part, for Pinfeed Printers
Your Price:
As low as $55.25
Serial Number: L0292



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.

 

·         3-part carbonless -- Top sheet color is white, middle sheet color is yellow, bottom sheet color is pink

·         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 to 48 hours; expedited shipping available.

 

Interested in a free sample? Click here.

 

 

Bulk Pricing:
Min Qty Price Per Unit
1 $63.85
3 $60.25
8 $57.50
10 $55.25
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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