Little Guy Software®

Big Guy Software Designed for the Little Guy

ORDERING FORM- for Software and Forms

Please Read - This form uses Javascript to do calculations automatically.  If you do not have javascript enabled in your web browser, you will need to do the calculations manually, after you complete and print out the form.   You can print the form using 'file' 'print'.  Enter the quantities, shipping costs and totals manually, if they have not calculated and printed automatically.

Please tell us who you are (red denotes required information):

SHIP TO ADDRESS:

Name  
Address  
be specific about suite or apartment nos.
City  
State  
Zip Code  
Company Name  
Email  
Phone  
Other Contact Info:  
I am a Returning Customer  
Returning Customers your Customer ID no. please (on your disk or CD)  

 ** Note that all CMS software and forms are for the NEW, Updated CMS (HCFA) 1500 (10/05).
All of our software is compliant with the new 2012 HIPAA 5010 standard **

EASYCMS 1500 SOFTWARE   for Windows

For use with the  UPDATED  CMS 1500 Forms

 Quantity Price

subTotal

EASYCMS 1500 Form Filler Software© -  for the updated CMS 1500 form. 
For individual clinicians only. (Companies/Groups/Organizations - see the Group Version Below) Customized Free. Delivered on CD.  

 

 48.50
+ $6.50 Shipping & Handling
EASYCMS 1500 Form Filler©  "Bundle"  -Customized  Software on CD and  500 updated CMS 1500 Forms - Individual Version only.  A Value Bundle. CD included. Free Shipping.

 

 76.50
EASYCMS 1500 Plus © - Software, Consultation, Training, Toll-Free Support and 500 FREE updated CMS 1500 claim forms.  Individual Version.  Customized Free. A Value Bundle. CD included. Free Shipping.

 

 124.50
EASYCMS 1500 Form Filler  Software© - GROUP VERSION  for the updated CMS 1500 form.   Customized Free. Delivered on CD.

 

98.50
+ $6.50 Shipping & Handling

EASYCMS 1500 SOFTWARE   for the Mac

For the UPDATED CMS 1500 Form

 Quantity Price

subTotal
EASYCMS 1500 Form Filler Software© -  for the updated CMS 1500 form.  For individual clinicians only.  (Companies/Groups/Organizations - see the Group Version Below)
Customized Free - See Below. Delivered on CD.

 

 64.50
+ $6.50 Shipping & Handling
EASYCMS 1500 Form Filler©  "Bundle"  -Customized  Software on CD and  500 updated CMS 1500 Forms - A Value Bundle- includes CD and Free shipping.

 

 93.50
EASYCMS 1500 Plus © - Software, Consultation, Training, Toll-Free Support and 500 FREE claim forms.  Individual Version.  Customized Free - See Below.   A Value Bundle- includes CD and Free shipping.  

 

 138.50
EASYCMS 1500 Form Filler  Software© - GROUP VERSION  for the updated CMS 1500 form.   Customized Free.  For group practices and organizations. Delivered on CD.

 

 114.50
+ $6.50 Shipping & Handling

UB 04 and HCFA 485 SOFTWARE (for Windows and Macs)

 Quantity Price

subTotal
UB 04 Form Filler for the UB 04. Delivered on CD.

 

 109.00
+ $6.50 Shipping & Handling
EASY HCFA 485  Software for the HCFA 485/486/487.
Delivered on CD.

 

 55.00
+ $6.50 Shipping & Handling

PRACTICE ENHANCEMENT SOFTWARE (for Windows)

(for all health care -Psychology, Psychiatry, Social Work, OT, PT, Etc.)

 Quantity Price

subTotal
Insurance Tracker Software - Single Clinician Version

Track health insurance authorizations and payments.  Stay alert to remaining sessions authorized and required reports.  Makes managed care easier (nothing makes it easy).  Generate patient bills.  You've never been this organized.  For Individual Clinicians. only  $89. on CD with free shipping.

 

 89.00
NEW   Insurance Tracker Software - Group Version

Unlimited Clinicians in one practice. Track health insurance authorizations and payments.  Stay alert to remaining sessions authorized and required reports. One click reports for each clinician or group practice. Create custom patient bills in just a few clicks. It's never been this easy. Network Capable.   $149. on CD with free shipping.

 

 149.00
NEW   Insurance Tracker Software - Biller's Version

Unlimited Clinicians in multiple practices. Track health insurance authorizations and payments.  Stay alert to remaining sessions authorized and required reports. One click reports for each clinician. Create custom patient bills in just a few clicks. It's never been this easy. Network Capable.    $149. on CD with free shipping.

 

 149.00

INSURANCE CLAIM FORMS

quality paper - quality printing

Shipping automatically calculated  if Javascript Enabled

 Quantity Price

subTotal

500 updated CMS 1500 Forms (laser cut sheets for inkjet or laser printers) -  New CMS 1500 forms  no longer contain Bar-Codes

 20.00
+ 8.50  S&H each		  

 
1000 updated CMS 1500 Forms (laser cut sheets for inkjet or laser printers)

 

 30.00
+ 9.00  S&H each
2500 (case) updated CMS 1500 Forms (laser cut sheets for inkjet or laser printers)

 

 37.50
+ 9.50  S&H each
2500 (case) CONTINUOUS Claim Forms (continuous sheets for tractor feed/pinwheel printers)

 

 37.50
+ 9.50  S&H each
UB 04 Claim Forms 2500 (case) (laser cut sheets for inkjet or laser printers)
For smaller quantities (500 or 1000) contact us for pricing

 

 37.50
+ 9.50  S&H each
Window Envelopes 500 - Right Hand Window (#10/10.5) for folded CMS forms
eliminates the need to print envelopes or make labels

 

 37.50
+ 8.50  S&H each
Window Envelopes 500 -  (9X12) - RH window. For unfolded claim forms
eliminates the need to print envelopes or make labels

 

 89.00
+ 9.00  S&H each
 

 

      

Please remember to add shipping if you are completing this form manually

  TOTAL:

Massachusetts Residents Must Add 6.25 % Sales Tax

Click here for a sales tax calculator

MA Residents Only Total with MA Tax

   Required for all Software Orders -

 please make certain the fields you highlight still appear highlighted after you print the order form

click to highlight a choice.


Profession:
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Operating System:
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Word Version (Microsoft Word is required for the EASYCMS 1500, UBEasy 04 and HCFA 485 products) It is not required for the Insurance Tracker
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Name and Model of your printer
Type of Printer
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Program To Be Used By:
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Program Customization for the CMS 1500 at no charge **
Supplier's Phone number for BOX 33

Supplier's Billing Name, Address, Zip (BOX 33)**
LIMIT 3 LINES, 30 CHARACTERS PER LINE (including spaces)
New CMS rules prohibit the use of symbols or punctuation on the form. Be clear about suite or apt. nos.

** this is required info if you are purchasing the Individual Version of EASYCMS 1500

 

Supplier's NPI for BOX 33

 

Where did you learn about our program?
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If Other, please specify

Any additional issues or requirements

payment via check or money order only.

  Make payable to: little guy software

   and send to

little guy software
56 So. Meadow Road
Plymouth, MA  02360

 

EASYCMS 1500 and UB 04 Software only Orders

Need your software order faster?  We can provide it as a download from our web site instead of sending a CD thru the mail. Costs are the same.

Check this box if you want a download of your order
(orders with forms and Insurance Tracker Software are CD only).

If you wish, click here to  
and send payment via US Mail. You will get a confirmation email. AOL users should submit the order on paper via US mail.
Email orders do not come thru on AOL.

or **Click to Print this order form** and send it along with your payment

 

If you have questions or difficulties with this order page,
 please contact our Customer Service Department

email     sales@littleguysoftware.com

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updated 1/22/2012