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Description

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 healthcare claims: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1) | ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250), Paper | Quill

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