CMS 1500

Form #
CMS 1500
Form Title
Health Insurance Claim Form
Revision Date
2012-02-01
O.M.B. #
0938-1197
O.M.B. Expiration Date
2020-03-31
CMS Manual
N/A
Special Instructions
Continue to use the current CMS Form 1500 (02-12) beyond the O.M.B. expiration date of 2020-03-31, pending O.M.B. completed review.

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