BLANK CHECK STOCK SMALLER QUANTITIESBuyBlankChecks.comTM A Company BLANK CHECK STOCK SMALLER QUANTITIESBuyBlankChecks.comTM A Company High QualityFast ShippingExceeds StandardsMultiple UsesCMS-1500CS-12 WCMS-1500CS-12 Health Insurance Claim Form Product highlights Approved by the National Uniform Claim Committee (NUCC) HIPAA compliant Printed with OCR “dropout” red ink on 20lb. paper (per government regulations) Certified Chain of Custody Promotes sustainable forest management Product description 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) 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. Economical 100 pack. Product Information Technical Details Brand Name BuyBlankChecks.com Item Weight 1 pounds Color White Material Type Paper Number of Items 100 Size 8.5-x-11-inch Sheet Size 8.5-x-11-inch Manufacturer Part Number WMCS-1500CS-12 Product highlights Approved by the National Uniform Claim Committee (NUCC) HIPAA compliant Printed with OCR “dropout” red ink on 20lb. paper (per government regulations) Certified Chain of Custody Promotes sustainable forest management Product description 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) 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. Economical 100 pack. Product Information Technical Details Brand Name BuyBlankChecks.com Item Weight 1 pounds Color White Material Type Paper Number of Items 100 Size 8.5-x-11-inch Sheet Size 8.5-x-11-inch Manufacturer Part Number WMCS-1500CS-12 Payment Shipping We accept the following payment methods: PayPalPayment through our websiteBitcoin (Contact us!)Electronic CheckCredit Card If paying any method aside from PayPal, please contact us through eBay after making your purchase so we can connect you to the appropriate payment portal. We ship most orders within 1 business day Monday – Friday and sometimes on Saturdays aside from postal holidays. Our standard shipping options are: First Class Mail* Priority Mail Priority Mail Express We also have the ability to ship via UPS and FedEx, although typically these are not cost effective. If you wish to use UPS or FedEx, please contact us for a shipping quote. ​​​​​​​* First Class Mail is only available for quantities of 25 and 50 due to limitations imposed by the USPS. Returns If you are not satisfied with items purchased from Diversified Company, please email us through the eBay system. We guarantee our products to the extent of proper quantity and stated quantity as ordered and as described. All products are checked for accuracy against your order before they are shipped, but an occasional error may occur. We maintain an electronic record of your order. If you inform us, and we verify that we have made an error, we will, at our cost, replace, if possible, the product to the proper specifications. Return of the erroneous product MAY not be required and in some cases, we may ask you to return the product at our expense. Errors must be reported within THREE DAYS of receiving your order! If your item arrives damaged, we reserve the right to order a return of the product, possibly at your expense. We may also ask for other means of proof of damage at our option, for example a photo of the damaged product in lieu or returning the physical product and to speed resolution. Returns are subject to a 20% restocking fee, to be deducted from any refund due to you. Buyer pays return shipping costs for returns not related to error on our part. This policy is an extension of any eBay return policy. Shipping Savings Shipping costs are calculated by eBay. Combined orders save on shipping costs, however sometimes eBay miscalculates those costs resulting in overpayment by you. We monitor purchases for this and will automatically issue a refund for overpayment within 1 business day after shipment.​​​​​​​BuyBlankChecks.com is a division of Diversified Company, an Indiana Corporation established in 2007.Product highlights —Approved by the National Uniform Claim Committee (NUCC) —HIPAA compliant —Printed with OCR “dropout” red ink on 20lb. paper (per government regulations) —Certified Chain of Custody —Promotes sustainable forest management Product description 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) 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. Economical 100 pack. Product Information Technical Details Brand Name BuyBlankChecks.com Item Weight 1 pounds Color White Material Type Paper Number of Items 100 Size 8.5-x-11-inch Sheet Size 8.5-x-11-inch Manufacturer Part Number WMCS-1500CS-12 BuyBlankChecks.comTM A Company BLANK CHECK STOCK SMALLER QUANTITIESFast ShippingMultiple UsesHigh QualityExceeds StandardsCMS-1500CS-12 WCMS-1500CS-12 Health Insurance Claim Form Product highlights Approved by the National Uniform Claim Committee (NUCC) HIPAA compliant Printed with OCR “dropout” red ink on 20lb. paper (per government regulations) Certified Chain of Custody Promotes sustainable forest management Product description 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) 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. Economical 100 pack. Product Information Technical Details Brand Name BuyBlankChecks.com Item Weight 1 pounds Color White Material Type Paper Number of Items 100 Size 8.5-x-11-inch Sheet Size 8.5-x-11-inch Manufacturer Part Number WMCS-1500CS-12 We accept the following payment methods: PayPalPayment through our websiteBitcoin (Contact us!)Electronic CheckCredit Card If paying any method aside from PayPal, please contact us through eBay after making your purchase so we can connect you to the appropriate payment portal. We ship most orders within 1 business day Monday – Friday and sometimes on Saturdays aside from postal holidays. Our standard shipping options are: First Class Mail* Priority Mail Priority Mail Express We also have the ability to ship via UPS and FedEx, although typically these are not cost effective. If you wish to use UPS or FedEx, please contact us for a shipping quote. ​​​​​​​* First Class Mail is only available for quantities of 25 and 50 due to limitations imposed by the USPS.If you are not satisfied with items purchased from Diversified Company, please email us through the eBay system. We guarantee our products to the extent of proper quantity and stated quantity as ordered and as described. All products are checked for accuracy against your order before they are shipped, but an occasional error may occur. We maintain an electronic record of your order. If you inform us, and we verify that we have made an error, we will, at our cost, replace, if possible, the product to the proper specifications. Return of the erroneous product MAY not be required and in some cases, we may ask you to return the product at our expense. Errors must be reported within THREE DAYS of receiving your order! If your item arrives damaged, we reserve the right to order a return of the product, possibly at your expense. We may also ask for other means of proof of damage at our option, for example a photo of the damaged product in lieu or returning the physical product and to speed resolution. Returns are subject to a 20% restocking fee, to be deducted from any refund due to you. Buyer pays return shipping costs for returns not related to error on our part. This policy is an extension of any eBay return policy. Shipping costs are calculated by eBay. Combined orders save on shipping costs, however sometimes eBay miscalculates those costs resulting in overpayment by you. We monitor purchases for this and will automatically issue a refund for overpayment within 1 business day after shipment.​​​​​​​BuyBlankChecks.com is a division of Diversified Company, an Indiana Corporation established in 2007. Product highlights Approved by the National Uniform Claim Committee (NUCC) HIPAA compliant Printed with OCR “dropout” red ink on 20lb. paper (per government regulations) Certified Chain of Custody Promotes sustainable forest management Product description 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) 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. Economical 100 pack. Product Information Technical Details Brand Name BuyBlankChecks.com Item Weight 1 pounds Color White Material Type Paper Number of Items 100 Size 8.5-x-11-inch Sheet Size 8.5-x-11-inch Manufacturer Part Number WMCS-1500CS-12