CMS-1500 Health Insurance Claim Form, One-Part (No Copies), 8.5 x 11, 250 Forms

ComplyRight® CMS-1500 Health Insurance Claim Form

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. Form Type Details: CMS-1500; Dated/Undated: Undated; Forms Per Page: 1; Form Size: 8.5 x 11.

• Global Product Type: Insurance Forms
• Form Type Details: CMS-1500
• Dated/Undated: Undated
• 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 in Days: 0
• Pre-Consumer Recycled Content Percent: 0%
• Post-Consumer Recycled Content Percent: 0%
• Total Recycled Content Percent: 0%

WARNING: This product can expose you to chemicals including Di(2-ethylhexyl)phthalate (DEHP), which is known to the State of California to cause cancer and birth defects or other reproductive harm. For more information, go to www.P65Warnings.ca.gov.

• This item cannot be shipped to PO Boxes.
• This item can be shipped only within the U.S.

• UPC: 758399422254 
• Mfr's Part #: CMS12LC250 

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