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Item #: TOP50122RV
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Description: Expedite Medicare, Medicaid or private insurance benefits. NUCC, CMS and AMA approved format. (02/12) version. Printed front and back in red OCR ink for scanning.
- 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.
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8 1/2 x 11
Forms Per Page:
1500 Health Insurance Claim Form
One Form per Sheet
Dot Matrix Pin Feed Holes
Print and Ruling Color(s):
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