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The CMS-1500 form is the standard claim form developed by the 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).
This package 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 of Health & Human Services. (Sold only
in packages of 100 blank forms under this stock number.)
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