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

Sku:

TOP50124RV

Upc:

025932512407

(0)
$128.92 / CT
$113.36 / CT
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List Price: $197.22
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  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 1500
Principal Heading 1500 Health Insurance Claim Form
Layout One Form per Sheet
Copy Types Two-Part Carbonless
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%
Footnote 1 Carbonless Duplicate
Special Features Carbonless Duplicate
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