Ream Forms CMS 1500 Claim Forms - HCFA 1500 (Version 02/12), Insurance Claims

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). Printed with OCR dropout red ink on 20 pounds. paper (per government regulations). Form not available personalized.