Little Guy Software®

Big Guy Software Designed for the Little Guy

ORDERING FORM- for NEW CMS 1500 Software and Forms

Yes, the update to be implemented in January, 2014 is called version 02/12

We strongly recommend that providers contact their health plans prior to submitting a claim
on the revised (02/12) 1500 Claim Form to ensure that they are prepared to accept the revised form.

** Special Offers - Lots of Discounts - on orders received by Nov. 30, 2013 **

1) Purchase the 02/12 CMS 1500 Form Filler "Bundle" or "Bundle Plus" of software and forms at regular price (unchanged from last year) and get the Insurance Tracker and/or Family Health Care Tracker  at 50% off.

2) Get an additional discount on the updated software if you purchased the current software version (08/05) within the last 2 years. (see the bottom of the order form for discount details). No rebates, just DISCOUNTS.

Please Read - This ordering 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.

Ordering Updated Versions  

Please tell us who you are (red denotes required information): NO HANDWRITTEN ORDERS. PLEASE TYPE ALL INFO

SHIP TO ADDRESS:

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

 ** Note that all CMS software and forms on this order form are for the NEW CMS (HCFA) 1500 called version 02/12, but is to be implemented in early 2014.  

EASYCMS 1500 SOFTWARE   for  Windows

For use with the  UPDATED  02/12  CMS 1500 Form

 Quantity Price

subTotal

EASYCMS 1500 Form Filler Software© -  for the NEW (02/12) CMS 1500 form. 
For individual clinicians only. (Companies/Groups/Organizations - see the Group Version Below) Customized Free. Delivered on CD.  

Delivered As A Download.  

55.00
+ $4.50 Shipping & Handling

55.00
Download

EASYCMS 1500 Form Filler©  "Bundle"  -Customized  Software on CD and  500 CMS 1500 Forms (New - 02/12) Individual Version only.  A Value Bundle. CD included. Free Shipping.

**Purchase this Bundle and get the Insurance Tracker and or Family Health Care Tracker at 50% off  the regular price - order must be received by Nov. 30, 2013

 

78.50
EASYCMS 1500 "Bundle Plus" © - Software, Consultation, Training, Free Phone Support and 500 FREE CMS 1500 (New - 02/12) claim forms.  Individual Version.  Customized Free. A Value Bundle. CD included. Free Shipping. This includes training on the changes to the new CMS 1500 form.

**Purchase this Bundle and get the Insurance Tracker and or Family Health Care Tracker at 50% off  the regular price - order must be received by Nov. 30, 2013

 
124.50
EASYCMS 1500 Form Filler  Software© - GROUP VERSION  for the (New - 02/12) CMS 1500 form.   Customized Free. Delivered on CD.

 

98.50
+ $6.50 Shipping & Handling

EASYCMS 1500 SOFTWARE   for the Mac

For the UPDATED  02/12  CMS 1500 Form

 Quantity
Price

subTotal

EASYCMS 1500 Form Filler Software© -  for the New(02/12) CMS 1500 form.  For individual clinicians only.  (Companies/Groups/Organizations - see the Group Version Below)
Customized Free - See Below. Delivered on CD.

Delivered As A Download.

71.00
+ $4.50 Shipping & Handling

71.00
Download

EASYCMS 1500 Form Filler©  "Bundle"  -Customized  Software on CD and  500 New CMS 1500 (02/12) Forms - A Value Bundle- includes CD and Free shipping.

 
95.50
EASYCMS 1500 "Bundle Plus" © - Software, Consultation, Training, Toll-Free Support and 500 FREE claim forms (02/12)  Individual Version.  Customized Free - See Below.   A Value Bundle- includes CD and Free shipping.   This includes training on the changes to the new CMS 1500 form

 
138.50
EASYCMS 1500 Form Filler  Software© - GROUP VERSION  for the new (02/12) 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 and Macs running Parallels

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

Quantity
Price

subTotal
Insurance Tracker Software - Single Clinician Version - for Windows

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.

* Take $44.50 off the price of this software if purchased with the Updated CMS 1500 "Bundle" or "Bundle Plus", by Nov. 30, 2013. (calculations at bottom of order form)

89.00
Insurance Tracker Software - Group Version - for Windows

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
Insurance Tracker Software - Biller's Version - for Windows

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

NEW   Family Health Care Tracker Software - for Windows

One-click summary reports on every past medical appointment for you and each member of your family including dates, procedures, dx, and follow ups. With built-in, pre-populated drop down menus you can add to, sort data by family member. See appointment dates, reason for visit, diagnosis, treatment and follow up. In two mouse clicks retrieve all colonoscopy dates or eye exams or mammograms or PSAs or vaccinations or dental cleanings, etc., in a clear, organized, printable report. See all future scheduled appointments for your family in one report. Print your current medication list to take to an appointment. Get a printout of your relevant family medical history. Get a summary of all of your copay or deductible payments for any time period you request. Keep all clinician phones nos. and email addresses in one location for easy access.  $89.00 on CD with free shipping.

* Take $44.50 off this software with purchase of the Updated CMS 1500 Bundle, by Nov. 30, 2013. (calculations at bottom of order form)

 
89.00

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) -  CMS 1500 forms no longer contain Bar-Codes (02/12)
20.00
+ 8.50  S&H each
  

 
1000 updated CMS 1500 Forms (laser cut sheets for inkjet or laser printers) (02/12)

 
30.00
+ 9.00  S&H each
2500 (case) updated CMS 1500 Forms (laser cut sheets for inkjet or laser printers) (02/12)

 
37.50
+ 9.50  S&H each
2500 (case) CONTINUOUS Claim Forms (continuous sheets for tractor feed/pinwheel printers) (02/12)

 
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) Correct for folded CMS forms.
Eliminates the need to print envelopes or make labels. The insurance co. address shows thru the window.

 
38.50
+ 8.50  S&H each
Window Envelopes 500 -  (9X12) - RH window. Correct for unfolded claim forms.
Eliminates the need to print envelopes or make labels. The insurance co. address shows thru the window.

 
89.00
+ 9.00  S&H each
 

Please remember to add shipping and tax (MA residents only) if you are completing this form manually

  TOTAL before discounts

SUPER DISCOUNTS:

 If you purchased the OLD (08/05) EASYCMS 1500 Form Filler in 2013 and are now purchasing the new 02/12 version as part of the software+forms "Bundle", take $15. off your total.
 If you purchased the OLD (08/05) EASYCMS 1500 Form Filler in 2012 and are now purchasing the new 02/12 version as part of the software+forms "Bundle", take $10. off your total.

AND

 If you are purchasing the Insurance Tracker Software with this order, take $44.50 off your total

AND

 If you are purchasing the Family Health Care Tracker Software with this order, take $44.50 off your total

 

NON Massachusetts Residents ONLY  enter the total sale amount (after any Discounts) $

---------------------------------------------------------------------------------

Massachusetts Residents   Total sale (after any Discounts) $

  Must Add 6.25 % Sales Tax -

Amount of sale
Mass Sales Tax
Total Amount Due

 

Massachusetts Residents Total Enclosed (after any Discounts) $

Required for all Software Orders -

click the drop down arrow to highlight a choice.


Profession:
click the down arrow for additional choices
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 or the Family HeallthCare Tracker
Type of Printer           Name and Model of your printer
   
Program To Be Used By:

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?
  scroll for additional choices     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

Print this order form from your Print menu or

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

click here to  
and send payment via US Mail. IF YOU DO NOT GET A CONFIRMATION EMAIL WITHIN A FEW HOURS, WE DID NOT RECEIVE YOUR EMAIL ORDER. You should see your order form load into your email program if the order is successfully going out via email. AOL users should submit the order on paper via US mail. Email orders do not come thru on AOL.

If you have questions or difficulties with this order page,
 please contact us email   sales@littleguysoftware.com

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updated 10/27/2013