CMS 1500 3941/2-R12

The approved timeline for use of the new forms are as follows: January 6th, 2014: Medicare begins receiving and processing paper claims submitted on the revised CMS 1500 claim form (version 02/12). January 6 through March 31st, 2014: Dual use period during which Medicare continues to receive and process paper claims submitted on the old CMS 1500 claim form (version 08/05). April 1st, 2014: Medicare receives and processes paper claims submitted only on the revised CMS 1500 claim form (version 02/12).

1240/2-R12: 2-part form NCR. White paper, red ink, 250/pack 1240L-R12: 1-part form. White paper, red ink, 500/pack 1240-S-R12: Padded form. White paper, red ink, 100/pad 3941/2-R12: 2-part NCR continuous form. White paper, red ink, 1000/case 3941-S-R12: 1-part continuous form. White paper, red ink, 1000/case