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CMS-1500 02-12 Claim Form

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The CMS-1500 02-12 Claim Form (formerly known as HCFA), is to be used by all medical facilities.  Per federal regulations, all healthcare providers must use the CMS-1500 Form (dated 02-12) for specific types of billing. The CMS-1500 02-12 Claim Form accommodates reporting of the National Provider Identifier, which must be used by all HIPAA-covered entities.

The CMS-1500 02-12 Claim Form is printed with OCR "dropout" red ink on 20# paper as per government regulations, and is available in continuous, laser-cut, and snap apart formats.

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