Tops HFCA Claim Form

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Tops HFCA Claim Form

2 Part - Carbonless - 11" x 8.50" Sheet Size - White - 100Set

Product Number: TOP50129R

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$18.16/ 100/PK

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	Estimated delivery: Fri 3/19 Thu 3/18 Orders over $75 Ship Free - see details REMINDER: NO SALES TAX (excludes WI and CA) Request volume price quote

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	Shipped by truck directly from the factory For manufacturer direct, estimated expected delivery Mon 3/29 Need a larger quantity? Manufacturer direct pricing is for you. Shipping from the manufacturer lets us save on shipping and operational costs, thereby saving you money. It may take a bit longer to arrive, but it allows us to offer you the best prices on the internet. FREE Shipping - see details Reminder - No Sales tax (excludes Wisconsin)

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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. Comes in a continuous format.

CMS-1500 claim forms (formerly known as HCFA-1500 claim forms) expedite Medicare, Medicaid or private insurance benefits.
Top sensor bar for microfiche duplication, as required in some states.
OCR red ink for scanning.

Product Specs

Product Information

Post-Consumer Recycled Content Percent	0 %
Pre-Consumer Recycled Content Percent	0 %
Total Recycled Content Percent	0 %
Paper Color(s)	White
Printer Compatibility	Dot Matrix
Format	Continuous Form Set
Punching	Dot Matrix Holes
Layout	One Form per Sheet
Paper Stock	20-lb.
Print and Ruling Color(s)	OCR Red
Principal Heading(s)	1500 Health Insurance Claim Form
Form Size (W x H)	8 1/2 in x 11 in
Copy Types	Black Print Carbonless Duplicate
Global Product Type	Forms-Insurance Claim
Product Type	Claim Form
Format	Continuous Form Set
Manufacturer Part Number	50129R
Manufacturer Website Address	www.tops-products.com
Shipping Weight	2 lb
Product Name	HFCA Claim Form
Brand Name	Tops
Country of Origin	United States
Layout	One Form per Sheet
Print	Red Ink
Recycled	No
Recycled Content	0%
Post-consumer-waste%	0%
Assembly Required	No
Sheet Size	11" Length x 8.50" Width White
Number of Parts	2 Part
Copy Type	Carbonless