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

Product ID:

386952

(0)
$103.26 / CT
$100.86 / CT
when buying 4+
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when buying in bulk
List Price: $189.86
You Save: -$86.60 (-46%)
Price: $103.26 / CT and get $2.10 back in Rewards
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  Estimated delivery time 2-3 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

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