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CMS 1500 Claim Forms - Chiropractor Claim Forms
We want you to be 100% satisfied. Our aim is to provide you with quality products at an affordable price. If an item does not meet your expectations, we'll gladly refund your money within 30 days after purchase. In order to keep our prices the lowest possible, some exceptions apply, including a 20% restocking fee applied after 30 days and 30% restocking fee applied after 60 days, should the item be in a usable condition. Please see our Returns section for detailed information.
PRICE MATCH GUARANTEE
If you find the same product for a lower price from any other company, we will refund/match the difference. Offer is valid for 30 days from the date of purchase. Valid on orders shipped within the continental United States. Cannot price match against auction sites. Pricing match is based on competitor complying with Manufacturer’s Minimum Advertised Price (MAP) Policy. If a product is listed below “MAP” we may not be able to match that price. Vendor that we price match must have product available to purchase and not on backorder.
- Approved by the National Uniform Claim Committee (NUCC); HIPAA compliant
- This form was revised to align the paper form with some of the changes in the electronic health care claims: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1)
- The most significant change was the addition of 8 diagnosis codes in field 21
- Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
- Printed with OCR "dropout" red ink on 20lb. paper (per government regulations)
- Form not available personalized
- Certified Chain of Custody; promotes sustainable forest management
- Size: 8-1/2x11"
- 1 Part Continuous (for pin style printers)
- 2 Part (carbon copy) Continuous (for pin style printer
- Laser (for standard laser printers)