TOPS Centers for Medicare and Medicaid Services Forms, 3000 Forms/Carton

Sku:

TOP50122RV

Upc:

025932512209

(0)
$108.70 / CT
$99.09 / CT
when buying 4+
Price Quote
when buying in bulk
List Price: $189.86
You Save: -$81.16 (-43%)
Price: $108.70 / CT and get $2.82 back in Rewards
Qty:
  Free Shipping
  Estimated delivery time 1-3 business days
  • CMS-1500 claim forms (formerly known as HCFA-1500 claim forms) expedite Medicare, Medicaid or private insurance benefits.
  • Top sensor bar for microfiche duplication, as required in some states.
  • OCR red ink for scanning.

Expedite Medicare, Medicaid or private insurance benefits. NUCC, CMS and AMA approved format. (02/12) version. Printed front and back in red OCR ink for scanning.

Specifications

Global Product Type Forms-Insurance
Form Size 8 1/2 x 11
Forms Per Page 1
Form Quantity 3000
Principal Heading 1500 Health Insurance Claim Form
Layout One Form per Sheet
Punching Dot Matrix Pin Feed Holes
Printer Compatibility Dot Matrix
Paper Stock 20-lb.
Paper Color White
Print and Ruling Color OCR Red
Pre-Consumer Recycled Content Percent 0%
Post-Consumer Recycled Content Percent 0%
Total Recycled Content Percent 0%
Special Features Continuous Form
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