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TOPS Tops HCFA Claim Form
1 Part - Carbonless - 9.5" x 11" Sheet Size - White - 3000 / Carton

Item Number: TOP50122R

Package Size: 1 Carton
One-part CMS-1500 forms comply with current physicians' standards for expediting Medicare and Medicaid payments
List Price $189.86
You Pay: $146.44
Delivery estimate: 7/31/2014
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Tops HCFA Claim Forms Without Sensor Bar - 2 Part - Carbonless - 11" x 8.5" Sheet Size - WhiteTops HCFA Claim Form Without Sensor Bar - 1 Part - Carbonless - 11" x 8.5" Sheet Size - White - 500 / Pack
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Description Specifications Reviews
  • One-part CMS-1500 forms comply with current physicians' standards for expediting Medicare and Medicaid payments
  • Each meets requirements of the Centers for Medicare and Medicaid Services, Champus and the AMA Council of Medical Service
  • Forms come in a continuous format.

Shipping Weight: 32 lbs.

Copy TypeCarbonless
FeaturesScannable
Form Quantity3000
Form Size (W x H)8 1/2 in x 11 in
Form Special FeaturesContinuous Form
Forms Per Page1
Global Product TypeForms-Insurance Claim
LayoutOne Form per Sheet
Number of Parts1 Part
Paper Color(s)White
Paper Stock20-lb.
Principal Heading(s)1500 Health Insurance Claim Form
PrintDouble Side, Red Ink, Blue Ink
Print and Ruling Color(s)OCR Red
Printer CompatibilityDot Matrix
Product NameHCFA Claim Form
Product TypeClaim Form
PunchingDot Matrix Holes
Sheet Size9.50" Length x 11" Width White
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