L P I Information Systems
LPI Information Systems
Toll-Free in USA: (888) 729-2020

DATASMITH   Catalog: Page

US flag
count
Still need it? We've still got it!!  Nobody ships it faster!!!
Human Resource Essentials     Changes for 2018     Form Layouts    TAX FORM CROSS REFERENCE
Need Help? To get email answers 24/7, CLICK HERE: forms@datasmithpayroll.com or Call 1-888-729-2020 for live, Toll-Free help 9am-6pm Central Time

CMS-1500 Health Insurance Claim Forms

for use by all medical facilities


Per the National Uniform Claim Committee (NUCC), all re-billing of claims is to be with the Version 02/12 form, even though earlier submissions may have been on the Version 08/05 form.

  • Significant changes from Version 08/05 in Version 02/12:
    Click to see details.


Version 02/12
CMS12LC CMS12LC CMS12LC
ITEM
NUMBER:
FORMS/PACK DESCRIPTION
Version 02/12 Laser CMS-1500 Forms:
CMS12LC 2500 LASER CUT SHEET
CMS12LC1 1000 LASER CUT SHEET
CMS12LC500 500 LASER CUT SHEET
CMS12LC250 250 LASER CUT SHEET
Version 02/12 Continuous CMS-1500 Forms:
CMS121 1000 1-PART CONTINUOUS pk 2500
CMS1211 1000 1-PART CONTINUOUS pk 1000
CMS122 1000 2-PART CONTINUOUS: WHITE/CANARY
CMS12W2 1000 2-PART CONTINUOUS: WHITE/WHITE
CMS123 1000 3-PART CONTINUOUS: WHITE/CANARY/PINK
Version 02/12 Continuous CMS-1500 Forms with Labels
CMS121B 1000 1-PART CONTINUOUS
CMS122B 1000 2-PART CONTINUOUS: WHITE/CANARY
Version 02/12 Snap-Apart CMS-1500 Forms:
CMS12S 1000 2-PART CONTINUOUS: WHITE/CANARY
The Center for Medicare and Medicaid Services (CMS) publishes the Medicare Claims Processing Manual which contains detailed instructions for filling out the CMS-1500 form. The manual is posted on-line as a downloadable PDF file.


Previous Catalog Page Catalog Index Customer Service View Cart ORDER Items on this Page Next Catalog Page

Need large quantity?...different packaging?...Get a competitive Custom Forms Quote!!
We'll e-mail our quote and create a special on-line order page just for you!

Valid W3C HTML 4.01 Transitional Valid CSS!