Shopping Cart

Your cart is empty.

Your cart is empty.

New CMS-1500 02/12 Claim Form (25 forms)

4.8 (5) Write Review
Free shipping on orders over $29.99

$14.44

$ 6 .99 $6.99

In Stock
  • 25 Forms - - 02/12 Version
  • All forms are government approved CMS-1500 to serve federal programs and private insurers as a universal claim form
  • Approved OMB-0938-1197 (02/12).


1 Part Laser (25 Single Sheets - for Laser/Inkjet Printers). 02/12 Version.......... Both CMS and the NUCC have issued their transition timelines, affecting providers that accept government and private insurance. Please check with your Payer / Insurance Companies


Jenna Romito
2025-08-11 15:46:58
Great form!
Cody
2025-07-04 10:16:28
Simple buy from this seller. Very easy.
Amanda
2025-05-02 13:09:29
Exactly what I needed to file for insurance
Ruth E Taylor
2025-04-28 15:44:52
Met my expectations. Was what I needed.
Moge
2024-12-11 16:59:31
Looks great! and works well with (1500cms.com) 02/12 Printable Template. Form is clear and and prints without jamming, good quality.