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TOPS HCFA Claim Form
Product Number: TOP50122RV
Sold Out
This product is sold out and we do not know when we will be getting another shipment. We apologize for any inconvenience this may cause.
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TOPS HCFA Claim Form
1 PartCarbonless Copy - 11" x 9.50" Sheet Size - White Sheet(s) - Red, Blue Print Color - 3000 / Carton
Description:
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. One-part forms come in a continuous format. Detached size of the 20 lb. paper is 8-1/2" x 11".
- Complies with current physicians' standards for expediting Medicare and Medicaid payments
- Meets requirements of the Centers for Medicare and Medicaid Services
- Meets requirements of Champus and the AMA Council of Medical Service
- Printed in OCR red ink for scanning
- Approved by NUCC
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Assembly RequiredNo
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Brand NameTops
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Certifications & StandardsAMA Council of Medical Service
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Country of OriginUnited States
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Environmental CertificationSustainable Forestry Initiative (SFI)
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Environmentally FriendlyYes
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FeaturesScannable
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Form Length8.50"
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Form Quantity3,000
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Form Size8.5 x 11 8.5 x 11
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Form Width11"
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Forms Per Page1
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Global Product TypeForms-Insurance
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Height9.5"
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LayoutOne Form per Sheet One Form per Sheet
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ManufacturerTops
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Manufacturer Part Number50122R
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Manufacturer Website Addresswww.tops-products.com
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Marketing InformationCMS-1500 form 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. Comes in a continuous format.
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Number of Parts1
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Packaged Quantity3000 / Carton
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Paper Color(s)White
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Paper Stock20 lb
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Post-Consumer Recycled Content Percent0%
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Post-consumer-waste%0%
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Pre-Consumer Recycled Content Percent0%
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Principal Heading(s)1500 Health Insurance Claim Form
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Print ColorBlue Red
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Print and Ruling Color(s)OCR Red
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Printer CompatibilityDot Matrix
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Product ColorWhite
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Product MaterialPaper
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Product NameHCFA Claim Form
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Product TypeClaim Form
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PunchingDot Matrix Pin Feed Holes
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RecycledNo
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Sheet Size11" Width x 9.50" Length
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Special FeaturesContinuous Form
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Total Recycled Content Percent0%
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Width11"