CMS 1500 Claim Forms - Chiropractor Claim Forms
Item Number:
796 0021
Manufacturer Part Number:
$12.67 - $122.59
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Description
New 1500 CMS Claim Forms
Where to Put Your Focus
Every Physician Makes a Good Referral
As of April 1, 2014, Medicare will only process paper claims submitted on the revised CMS 1500 claim form
Available Formats
- 1 Part Continuous (for pin style printers)
- 2 Part (carbon copy) Continuous (for pin style printer
- Laser (for standard laser printers)
Allows healthcare providers to bill a patient's insurance company for reimbursement
- Approved by the National Uniform Claim Committee (NUCC); HIPAA compliant
- 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)
- The most significant change was the addition of 8 diagnosis codes in field 21
- Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
- Printed with OCR "dropout" red ink on 20lb. paper (per government regulations)
- Form not available personalized
- Certified Chain of Custody; promotes sustainable forest management
- Size: 8-1/2x11"