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| Health Insurance Claim Form (CMS-1500) (Double Sheets with Carbon) |
| Availability |
Superseded |
| Stock Number |
017-060-00469-0 |
| ISBN |
0-16-034549-9 |
| Price |
$20.00 |
| International Price |
$ 28.00 |
| Description |
Form CMS-1500. Form OWCP-1500. Form RRB-1500. Formerly called HCFA-1500. Health insurance claim form used for various government and private health programs: Railroad Retirement Board (RRB-1500); Office of Worker Compensation Programs (OWCP-1500) as well as Black Lung, Federal Employees' Compensation Act (FECA), and Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) claims (CMS-1500). Approved by AMA (American Medical Association)Council on Medical Service, 8/88. Consists of two copies of form attached with carbon between. Sold in packages of 100 copies only. |
| Publisher |
Health and Human Services Dept., Centers for Medicare and Medicaid Services |
| Year/pages |
1990: 2 p. |
| Note |
Supersedes HE 22.32:1500(2)(SC)(1-84), S/N 017-060-00176-3. THIS FORM IS SENSOR CODED ONLY. S/N 017-060-00469-0 was earlier used for: Health Insurance Claim Form, Form HCFA-1500, which has been superseded. The form CMS-1500 will have a form date of 8/05. It can still be used until 3/30/07. |
| Key Phrases |
Medicaid, HCFA 1500, OWCP 1500, RRB 1500, FECA, CHAMPUS, Medical Insurance |
| SuDocs Class |
HE 22.32:HCFA-1500(12-90) |
| Author |
|
| Weight |
2 lbs. 5 oz. |
| Quantity Price |
Discount |
| Binding |
Specialty Item |
| Cover |
|
| Available Date |
10/02/91 |
| Subject Bibliography |
090HD 294LY |
| Status Date |
03/01/06 |
| Unit |
Package |
| Unit (non-U.S.) |
Each |
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