Description
- 2 Part Hand Written (50 Single Sheets) 02/12 Version
- For Hand Written Claims Only
- 2 part carbonless (NCR) paper. Provides users with duplicate copy.
- Accommodates reporting of the National Provider Identifier (NPI) number
- Approved OMB-0938-1197 (02/12). Payers will begin to accept these forms starting January 6th, 2014. And will only accept this version as of April 1st, 2014
Paper are printed in OCR-scannable red ink. All forms are government approved CMS-1500 to serve federal programs and private insurers as a universal claim form.
