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Home > CLAIM FORMS > Version 02/12 CMS-1500 Laser/Inkjet Insurance Claim Form (2,500/BX)
Version 02/12 CMS-1500 Laser/Inkjet Insurance Claim Form (2,500/BX)
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Item Number: WCMS1500CS-12
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Version 02/12 is the current approved CMS 1500 Claim Form. 2500 Per Box. UPS SHIPPING COSTS WILL BE ADDED TO THE ORDER.
The CMS-1500 contains a number of improvements and enhancements that include better alignment with the electronic HIPAA ASC X12N 837-non Institutional Transaction Standard. The New 1500 paper claim form will be able to accommodate the reporting of the National Provider Identifier (NPI) Number. The NPI will be a single provider identifier, replacing the different provider identifiers healthcare systems currently use for each health plan with which you do business. The NPI Identifier, which implements a requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), must be used by all HIPAA covered entities, which are health plans, healthcare clearinghouses, and healthcare providers.
$19.99 PER BOX SHIPPING
Additional Information
For details on the Form Update, Click Here
The NUCC approved the following transition timeline at its in-person meeting in Chicago, IL on August 1, 2013.
- January 6, 2014: Payers begin receiving and processing paper claims submitted on the revised 1500 Claim Form (version 02/12).
- January 6 through March 31, 2014: Dual use period during which payers continue to receive and process paper claims submitted on the old 1500 Claim Form (version 08/05).
- April 1, 2014: Payers receive and process paper claims submitted only on the revised 1500 Claim Form (version 02/12).
This timeline aligns with Medicare’s transition timeline. |
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9.5 x 12 Designed for Submitting up to 50 Claim Forms Per Envelope
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