Office Products > Forms, Recordkeeping & Money Handling > Human Resources Forms > Insurance Claim Forms
TOPS CMS-1500 Health Insurance Claim Forms for Laser Printer, 8.5 x 11 Inches, 250 Sheets per Pack (50135RV),White
Product ID: B00IGJ891Y
Condition: New
Selected Option: 11 x 8.5
$ 97
includes Duties & VAT
Delivery: 10-20 working days
Ships from USA warehouse.
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Product Description
TOPS CMS-1500 Health Insurance Claim Forms for Laser Printer, 8.5 x 11 Inches, 250 Sheets per Pack (50135RV),White
- Sold as 250/Pack.
- Top sensor bar for microfiche duplication, as required in some states.
- OCR red ink for scanning.
- OCR red ink for scanning.
- Made in the USA.
The TOPS CMS-1500 Health Insurance Claim Form is the standard paper claim form used to bill Medicare Fee-For-Service (FFS) Contractors when a paper claim is allowed. It is approved by the National Uniform Claim Committee (NUCC) and the Office of Management and Budget (OMB). Designed for use with a laser printer, the form is printed in red optical character recognition (OCR) ink on 20-lb., white bond paper. It is 8-1/2" x 11" and comes 250 forms per pack. This version (02/12) went into use January 6, 2014.
Technical Specifications
Country
USA
Brand
Tops
Manufacturer
TOPS Products
PartNumber
50135RV
Model
50135RV
Color
White
Height
1.1
Length
11
Weight
2.59
Width
8.5
ReleaseDate
2018-08-17T00:00:01Z
Size
11 x 8.5
NumberOfItems
1







