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

by TOPS | Item  #: 954544 | Model #:  TOP50124RV |
(6) |
TOPS Centers for Medicare and Medicaid Services Forms, Two-Part, 1500 Forms

 

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  • $ 167 38
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About this item

  • 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.
  • Description

    CMS-1500 claim forms (formerly known as HCFA-1500 claim forms) expedite Medicare, Medicaid or private insurance benefits. OCR red ink for scanning.

    Specifications

    • GLOBAL PRODUCT TYPE: Forms-Insurance Claim
    • FORM SIZE: 11 x 8 1/2
    • FORMS PER PAGE: 1
    • FORM QUANTITY: 1500
    • PRINCIPAL HEADING(S): 1500 Health Insurance Claim Form
    • LAYOUT: One Form per Sheet
    • COPY TYPES: Carbonless Duplicate
    • PUNCHING: Dot Matrix Holes
    • PRINTER COMPATIBILITY: Dot Matrix
    • PAPER STOCK: 20-lb.
    • PAPER COLOR(S): White
    • PRINT AND RULING COLOR(S): OCR Red
    • FOOTNOTE 1: Carbonless Duplicate
    • SPECIAL FEATURES: Carbonless Duplicate

    * Pricing valid online only, December 1 - December 6, 2015, unless otherwise noted. No rain checks. While supplies last.

    Assembled Country

    United States

    Assembled Size

    8.5"W x 11"H

    Component Country

    USA

     

     

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    Standard - 2 to 6 business days

  • Delivery is not available to AK, HI or Puerto Rico

    Warranty Information

    This product is covered by the Sam's Club Member Satisfaction Guarantee.