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

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. Department of Health & Human Services. (Sold only in packages of 100 blank forms under this stock number.)

What is the CMS-1500 Form? The CMS-1500 form is the standard claim form developed by the National Uniform Claim Committee (NUCC) and used by all non-institutional medical providers or suppliers 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).

The CMS-1500 form is the standard claim form developed by the National Uniform Claim Committee (NUCC) and used by all non-institutional medical providers or suppliers 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).