TOPS Centers for Medicare and Medicaid Services Forms, Two-Part, 1500 Forms

Sku:

TOP50124RV

Upc:

025932512407

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$114.28 / CT
$108.96 / CT
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List Price: $197.22
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  • 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

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