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CMS-1500 Laser Sheet Insurance Claim Form, Version 02/12

    •  
    • 60150X
    • 500
    • $38.00 $0.08 each
    • 1000
    • $58.00 $0.06 each
    • 1500
    • $80.00 $0.05 each
    • 2000
    • $104.00 $0.05 each
    • 2500
    • $127.00 $0.05 each
    • 5000
    • $259.00 $0.05 each
    • 7500
    • $384.00 $0.05 each
    • 10000
    • $510.00 $0.05 each
    • 15000
    • $763.00 $0.05 each
    • 20000
    • $991.00 $0.05 each
    • 25000
    • $1,240.00 $0.05 each
    • 30000
    • $1,486.00 $0.05 each
    • 50000
    • $2,353.00 $0.05 each
    • 62500
    • $2,942.00 $0.05 each
    • 75000
    • $3,441.00 $0.05 each
    • 100000
    • $4,175.00 $0.04 each
    • 160000
    • $5,747.00 $0.04 each

Product Specifications

  • Ref.: 60150X
  • Size: 8 1/2" x 11"
  • Convenient and easy to use! 1-part form on 20# white bond stock, printed in OCR red ink.
  • Accommodates NPI numbers as mandated by HIPAA.
  • Accepted by most health insurance companies.
  • Single sheet format works with most laser printers.
  • Quantity: Comes in packs of 500.
  • Min. Qty. 500

Product Description

Speed third-party billing and manage your cash flow with this AMA and CMS approved claim form for your laser printer. Includes all updates to the 02/12 version approved by the NUCC (National Uniform Claim Committee)

Turnaround Time

Turnaround:

Up to 48h + Shipping

Turnaround times above are only estimates. Orders with corrupt artwork, missing fonts, low resolution logos, too much text in the personalization, etc. will be delayed until that issue is resolved.

The processing of your order will only start once the issue has been resolved. Finally, although very rare, issues such as a broken plates can occur and may also delay your order, so please try to plan a printing job well in advance of your deadline.

Orders placed after 2pm will be processed the next business day.

Shipping Destinations

Destinations:

U.S.A. and Canada

Shipping Methods:

UPS (Ground, Second Day Air or Next Day Air)

Shipping charges are calculated based on the final amount of your order, please see our Shipping Chart to find out more.