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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. 

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

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

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

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

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

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

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

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

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

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

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