Office Supplies → Forms, Recordkeeping & Reference Materials → TOPS 50124RV Centers for Medicare and Medicaid Services Claim Forms, CMS1500/HCFA1500, Two-Part, 1500 Forms/Carton (TOP50124RV)

TOPS 50124RV Centers for Medicare and Medicaid Services Claim Forms, CMS1500/HCFA1500, Two-Part, 1500 Forms/Carton (TOP50124RV)

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Summary
  • 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.

Product Description

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. Carbonless Duplicate—Continuous Form. Form Size: 8 1/2 x 11; Forms Per Page: 1; Form Quantity: 1500; Principal Heading(s): 1500 Health Insurance Claim Form.

Product Specs

Global Product TypeForms-Insurance
Form Size8 1/2 x 11
Forms Per Page1
Form Quantity1500
Principal Heading(s)1500 Health Insurance Claim Form
LayoutOne Form per Sheet
Copy TypesTwo-Part Carbonless
PunchingDot Matrix Pin Feed Holes
Printer CompatibilityDot Matrix
Paper Stock20-lb.
Paper Color(s)White
Print and Ruling Color(s)OCR Red
Pre-Consumer Recycled Content Percent0%
Post-Consumer Recycled Content Percent0%
Total Recycled Content Percent0%
Footnote 1Carbonless Duplicate
Special FeaturesCarbonless Duplicate-Continuous Form.
Country of OriginUS
Carton Weight31 lbs.
Carton Pack Quantity1500 ST
UNSPSC14111806

Shipping Weight & Item Dimensions

Weight31
Width10.125
Height12.5
Depth11.625

National Chemical Laboratories
Victory Innovations