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Your cart is empty.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 20 pounds. paper (per government regulations). Form not available personalized. Certified Chain of Custody; promotes sustainable forest management. Size: 8-1/2x11".
hummingbird
August 18, 2025
These have never jammed in our printers.
Vladislav Kostin
August 11, 2025
Just what we needed! Work perfectly with our printer and EHR. Will buy again!
jessgyu
July 26, 2025
Great
LNMD93
July 16, 2025
I bought these forms and the last time I ordered 2500 of them. After I bought them I blamed my ink jet printer as the printer was not aligning right with the form. Our computer tech tried to re-align the forms to print properly.. We wasted half the forms due to not being able to line them up properly to send to insurance companies. DO NOT BUY THIS FORM. It will not align correctly with your printer.
Mag S.
June 19, 2025
Good price. Arrived on time. Highly recommended.
drmitchells
June 4, 2025
just a little bigger than my previous ones....
Tina Smith
April 28, 2025
Great for work.
TN
January 11, 2025
The color red on the form is too light. It's more like pink then red. I prefer those that I have previously purchased from a different vendor.
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