New
Original price was: $37.99.$28.87Current price is: $28.87.
- No Compromise on Quality
- 7 days free returns
- Multiple payment methods, 100% payment security
- Sustainable materials, for a better tomorrow.
This form was revised to align the paper form with some of the changes in the electronic health care claims: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1)
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Approved by the National Uniform Claim Committee (NUCC); HIPAA compliant
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The most significant change was the addition of 8 diagnosis codes in field 21
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Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
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Printed with OCR “dropout” red ink on 20lb. paper (per government regulations)
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Form not available personalized
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Certified Chain of Custody; promotes sustainable forest management
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Size: 8-1/2 x 11″
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1,000 per carton
| Brand | TFP |
|---|---|
| Customizable | No |
| HR Form Pack Size | 1000 |
| HR Form Type | Cms-1500 |
| Number of Parts | 1 |
| Pack Qty | 1000 |
| Quick Ship | Yes |
| True Color | White |
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