Centers for Medicare and Medicaid Services Claim Forms CMS1500/HCFA1500, 3000 Forms/Carton
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US$35.39
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Product details
| Management number | 254301381 | Release Date | 2026/11/07 | List Price | US$35.39 | Model Number | 254301381 | ||
|---|---|---|---|---|---|---|---|---|---|
| Category | |||||||||
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. Continuous Form. Form Size: 8 1/2 x 11 Forms Per Page: 1 Form Quantity: 3000 Principal Headings: 1500 Health Insurance Claim Form.
- Product Type - Forms-Insurance
- Form Size - 8 1/2 x 11
- Forms Per Page - 1
- Form Quantity - 3000
- Principal Headings - 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 Colors - White
- Print And Ruling Colors - OCR Red
- Pre-consumer Recycled Content Percent - 0%
- Post-consumer Recycled Content Percent - 0%
- Total Recycled Content Percent - 0%
- Special Features - Continuous Form
- Assembly Code - N
- Prop 65 Indicator - N
- Green Indicator - N
- EPACPGCompliant Code - N
| Standard form & application type | Claim Form |
|---|---|
| Model | 50122RV |
| Paper size | 9 1/2" x 11" |
| Brand | Tops |
| Sheets | 3000 |
| Material | Paper |
| Piece count | 3000 |
| Color | White |
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