Health Insurance Claim Forms

The CMS-1500 form is the official standard Medicare and Medicaid health insurance claim form required by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health & Human Services. It was developed by the independent National Uniform Claim Committee (NUCC) and used by all non-institutional medical provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims. It is also used for billing of some Medicaid State Agencies (contact your Medicaid State Agency for more details).

Claims must be submitted on original, not photocopied, print versions of the CMS-1500 forms as they are printed in special OCR-scannable red ink. Original, blank forms are available from GPO in several convenient laser-printed compatible quantities and formats, such as single sheet, 1-part, 2-part, and 2-part snapout versions. 

5 items
2012 Medicare Health Insurance Claim Forms (CMS-1500) 2-Part Snapout 100-Pack

Health Insurance Claim Forms (CMS-1500) 2-Part Snapout (Package of 100) (2012)

By: Health and Human Services Dept., Centers for Medicare and Medicaid Services

GPO Stock # 017-060-00661-7 ISBN:

This consists of 100 original, blank 2-Part Snapout forms of the February 2012 Revision of the official CMS-1500 Medicare and Medicaid health insurance claim form required by the Centers for Medicare & Medicaid Services (CMS) of the U.S....

Price: $35.00
2012 Medicare Health Insurance Claim Forms CMS-1500 1-part Continuation 2500-pk

Health Insurance Claim Forms (CMS-1500) 1-part Continuation (2012) (Package of 2500)

By: Health and Human Services Dept., Centers for Medicare and Medicaid Services

GPO Stock # 017-060-00664-1 ISBN:

This consists of 2500 original, blank 1-Part Continuation forms of the February 2012 Revision of the official CMS-1500 Medicare and Medicaid health insurance claim form required by the Centers for Medicare & Medicaid Services (CMS) of the U.S...

Price: $97.00
2012 Health Insurance Claim Forms (CMS-1500) 2 Part Continuation (1400-pk)

Health Insurance Claim Forms (CMS-1500) 2 Part Continuation (Package of 1400) (2012)

By: Health and Human Services Dept., Centers for Medicare and Medicaid Services

GPO Stock # 017-060-00662-5 ISBN:

This consists of 1400 original, blank 2-Part Continuation forms of the February 2012 Revision of the official CMS-1500 Medicare and Medicaid health insurance claim form required by the Centers for Medicare & Medicaid Services (CMS) of the U.S...

Price: $94.00
 Health Insurance Claims Forms (CMS-1500) Single Sheets (Revised 2012)

Health Insurance Claims Forms (CMS-1500) Single Sheets (Revised 2012)

By: Health and Human Services Dept., Centers for Medicare and Medicaid Services

GPO Stock # 017-060-00663-3 ISBN:

This consists of 100 original, blank single sheets of the February 2012 Revision of the official CMS-1500 Medicare and Medicaid health insurance claim form required by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department...

Price: $32.00
Book Cover Image for Authorization for Examination and/or Treatment, Form CA-16

Authorization for Examination and/or Treatment, Form CA-16

By: Labor Dept., Employment Standards Administration, Office of Workers' Compensation Programs

GPO Stock # 029-016-00219-7 ISBN: 0-16-075173-X

Physician's authorization form for Medical Examination and/or Treatment for Workers' Compensation cases.

Form CA-16, Rev. Feb. 2005. Issued with perforations. Expires October 31, 2008. Includes form, instructions, and information for...

Price: $31.50
5 items