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The form specifications require red drop out ink in order to
facilitate the use of image processing technology such as Image
Character Recognition (ICR), facsimile transmission and image
storage. It is available in various formats (e.g., single copy,
duplicate, etc.). CMS and
contractors do not provide the form to providers for claim
submission. Forms may be purchased form the US Government Printing
Office at:
US Government Printing Office
Superintendent of Documents
Washington, DC 20402
(866) 512-1800
(202) 512-1800 (Pricing Desk)
(202) 512-2250 (Fax)
or
Order Department
AMA
PO Box 109050
Chicago, IL 60610-9050
American Express, Visa and Master Card orders; call 800/621-8335
Please send an e-mail to
info@MedClaimSoftware.com with any comments
or questions you might have. |
