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CMS 1500 Laser Health Insurance Form, 02/12 Ver. (보험 양식)

Item # 2383
CMS 1500 Laser Health Insurance Form, 02/12 Ver. (보험 양식)
CMS 1500 Laser Health Insurance Forms, 02/12 Version
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Description


CMS 1500 Laser Health Insurance Forms, 02/12 Version

  • 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)
  • Certified Chain of Custody; promotes sustainable forest management
  • Size: 8-1/2 x 11"
  • 500 per carton


Specification

  • Form Type : Billing
  • Format : Health Insurance Claim Form
  • Lines : No Lines
  • Binding Type : Loose
  • Paper Color : White
  • Number of Parts : 1
  • Carbonless : Yes
  • Numbered : No
  • Holes Punched : None
  • Personalization : No
  • Security Features : No
  • Certifications & Standards : SFI Sustainable Forestry Iniative
  • Country of Origin : USA


CMS 1500 보험 양식, 02/12 개정

NUCC(National Uniform Claim Committee) 인가, HIPAA 규칙 준수

본 양식은 전자 의료 클레임 양식 변경에 맞춰 새로 수정된 02/12 개정 양식이며 카본지가 포함되어 있지 않습니다.

크기: 8-1/2 x 11"
500 장


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