Sub total:
$138.00
total:
$138.00
Centers for Medicare and Medicaid Services Forms, Two-Part, 1500 Forms
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.
| $28.87USD | Retail $197.22 |
Manufacturer:
TOPS BUSINESS FORMS
Item:
50124RV
UPC Code:
025932512407
Condition
New
Extended Warrenty
| 1 Year Extended Warrenty | $5.77 |
$28.87USD
$197.22
$197.22
Availability
In Stock
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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.
Specifications
Copy Types
Two-Part Carbonless
Footnote 1
Carbonless Duplicate
Form Quantity
1500
Form Size
8 1/2 x 11
Forms Per Page
1
Global Product Type
Forms-Insurance
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
Dot Matrix
Punching
Dot Matrix Pin Feed Holes
Special Features
Carbonless Duplicate
Special_Benefit_Statement
Continuous Form.
Total Recycled Content Percent
0%
