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How to fill out a CMS-1500 form The Jotform Blog
WebNov 20, 2013 · cs1500 form. 1500 medical claim forms. insurance claim forms. Next page. Product Description . TOPS CMS-1500 Health Insurance Claim Forms are approved by the National Uniform Claim Committee (NUCC) and the OMB. For use with laser printers, these forms are printed in red OCR ink on white 20# bond paper. They measure 8.5 x 11 … WebJul 28, 2010 · Resubmit a photocopy of the original claim or a new claim form; Enter the items listed below; Initial and date the form if it is a photocopy, or sign and date the form if it is a new form; and. Mail the void request to the fiscal agent for processing at: Adjustments and Voids P.O. Box 7080 Tallahassee, Florida 32314-7080. Billing instruction fisher shermanology it\u0027s a killa
Box 30 - Reserved for NUCC Use – Therabill
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