Centers for Medicare and Medicaid Services Forms, 8 1/2 x 11, 250 Forms/Pack

SKU: 7300035081

Mfg: TOPS™

Mfg part #: TOP50135RV

$31.12

Savings: $8.28 (21.01 %)

Pack 250 EA/PK

Availability: In stock

Reward Points: 3

Qty:

Delivery date: Typically 3-5 days, but due to COVID related issues, there may be a delay

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. Top sensor bar for microfiche duplication, as required in some states. OCR red ink for scanning. Form Size: 11 x 8 1/2; Forms Per Page: 1; Form Quantity: 250; Principal Heading(s): 1500 Health Insurance Claim Form.

Products specifications

UOM
Pack	250 EA/PK
Form Quantity	250
Form Size	11 x 8 1/2
Forms Per Page	1
Global Product Type	Forms-Insurance Claim
Layout	One Form per Sheet
Paper Color(s)	White
Paper Stock	20-lb.
Post-Consumer Recycled Content Percent	0%
Pre-Consumer Recycled Content Percent	0%
Principal Heading(s)	1500 Health Insurance Claim Form
Print and Ruling Color(s)	OCR Red
Printer Compatibility	Laser
Special Features	For Laser Printers
Total Recycled Content Percent	0%
UBN	COST
UBN	IMAGE
Category	Forms
Manufacturer	TOPS™