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accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, Attn: PRA Reports Clearance Officer, 7500 Security Boulevard, Baltimore, Maryland 21244 …
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- https://www.cms.gov/.../PRA-Listing-Items/CMS-1500
Sep 12, 2019 · CMS-1500 CMS Form Number. CMS-1500. Date. 2019-09-12. Subject. Health Insurance Common Claims Form. Downloads. CMS-1500 (ZIP) Home A federal government …
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APPROVED OMB-0938-1197 FORM 1500 (02-12) 1a. INSURED’S I.D. NUMBER (For Program in Item 1) 4. INSURED’S NAME (Last Name, First Name, Middle Initial) 7. INSURED’S ADDRESS …
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