Forms, Recordkeeping & Reference Materials
Out of Stock
ComplyRight® CMS-1500 Health Insurance Claim Form, One-Part (No Copies), 8.5 x 11, 250 Forms Total
List Price
$18.21 /each
Meet billing requirements for Medicare Part B.
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Product Overview
Meet billing requirements for Medicare Part B. Easy-to-read forms with crisp, clean text help ensure faster claims processing. Paper, layout and ink comply with CMS standards and requirements. Layout includes all 02/12 NUCC revisions and is a direct replacement for the previous 08/05 version. Printed in scannable, OCR "dropout" red ink.
| Item # | TFPCMS12LC250 |
| SKU | CMS12LC250 |
| UPC | 758399422254 |
| Brand | ComplyRight® |
| Category | Forms, Recordkeeping & Reference Materials |
| Sub Category | Forms |
| List Price | $18.21 |
| Country of Origin | US |
| Dimensions | 11.224" L x 8.714" W x 1.29" H |
| Weight | 2.5980 lbs |
| Global Product Type | Insurance Forms |
| Form Type Details | CMS-1500 |
| Dated | No |
| Forms Per Page | 1 |
| Form Size | 8.5 x 11 |
| Sheet Size | 8.5 x 11 |
| Format Indicator | Unbound |
| Form Quantity (Total) | 250 |
| Copy Types | One-Part (No Copies) |
| Principal Heading(s) | 1500 Health Insurance Claim Form |
| Paper Color(s) | White |
| Color Family | White |
| Print and Ruling Color(s) | OCR Red |
| Product Biodegradability Indicator | N |
| Product Compostability Indicator | N |
| Pre-Consumer Recycled Content Percent | 0% |
| Post-Consumer Recycled Content Percent | 0% |
| Total Recycled Content Percent | 0% |
Carton Info
| Count | 2 PK / Carton |
| Weight | 21 lbs / Carton |
| UPC | 758399422254 |
| Product Type | FORM,FORM,CMS1500(0212)LS |
Product Highlights
- Meet billing requirements for Medicare Part B.
- Easy-to-read forms for faster claims processing.
- Comply with CMS standards and requirements for paper, layout and ink.
- Printed in scannable, dropout OCR red ink.
Ships via standard ground delivery. Allow 3-5 business days.
Item Weight: 2.5980 lbs
Dimensions: 11.224" L x 8.714" W x 1.29" H