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New Blank CMS-1500 (HCFA) Form Version 02/12 and Envelope Sets

New Blank CMS-1500 (HCFA) Form Version 02/12 and Envelope Sets
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Name: New Blank CMS-1500 (HCFA) Form Version 02/12 and Envelope Sets
Your Price:
As low as $35.43
Serial Number: L0279



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. Purchase the forms and corresponding envelopes together … and save!

 

Forms:

·         Use soy-based OCR "dropout” red ink for greater scanning accuracy

·         Printed on SFI (Sustainable Forestry Initiative) paper

·         Feature Anti-Rejection Projection™* -- guaranteed acceptance by insurance carriers for rejection-proof claim filing and quicker payment

Envelopes:

·         Standard 4 ½” x 9 ½”, self-seal envelope

·         Right window format

·         Accommodates up to 12 folded CMS-1500 forms

 

Available in sets of 500, 1,000 or 2,500 (includes 500, 1,000 or 2,500 CMS-1500 forms, PLUS 1, 2 or 5 boxes of 500 CMS-1500 envelopes).

 

Interested in a free sample? Click here.

 
Bundle and Save!

 

Item

Retail Price

Bundled Price

Your Savings

2500 CMS-1500 Forms

$37.95

$28.46

$9.48

2500 CMS-1500 Envelopes

$125.00

$93.75

$31.25

TOTAL

$162.95

$122.21

$40.73

 

 

 

 

Form and Envelope Sets:
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Bulk Pricing:
Min Qty Price Per Unit
500 $35.43
1000 $63.91
2500 $122.21
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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