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

Name: CMS-1500 Health Insurance Claim Form, One-Part (No Copies), 8.5 x 11, 250 Forms Total
Brand: ComplyRight®
SKU: TFPCMS12LC250
Price: 20.81 USD
Availability: OutOfStock

Item # TFPCMS12LC250

Brand: ComplyRight®

Ask a Question

Click image to zoom in

Status: Out of Stock

Ships via

Item is not available for purchase

This product is not currently available for purchase. This may be because of insufficient stock or because the manufacturer has discontinued this item.

Save 28% over Staples price of $29.09

* Disclaimer

The competitor pricing information we've provided is for reference only. We strive to keep our data current but occasionally pricing may be out of date. Comparison pricing does not reflect any on-going promotion, discount or contract pricing. Comparison also does not include tax or shipping costs. Office Depot and Staples are copyright trademarks of their respective owners.

Product Variations

View List

One-Part (No Copies), 8.5 x 11, 250 Forms Total

NET-30 Terms with Credit Key

Learn More

Running Low on Ink or Toner?

Use our Ink & Toner Finder

Product Details

Product Highlights

Meet billing requirements for Medicare Part B.
Easy-to-read forms for faster claims processing.
Comply with CMS standards and requirements for paper, layout and ink.
Printed in scannable, dropout OCR red ink.
Include all 02/12 NUCC revisions, replacing the previous 08/05 version.

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 Size: 8.5 x 11; Forms Per Page: 1; Form Quantity: 250; Sheet Size: 8.5 x 11.

Product Specifications

Dimensions / Specifications
Unit of Measure	PK
Item Dimensions	8.71 in. x 1.29 in. x 11.22 in. (W x H x D)
Item Weight	2.598 lbs
Carton Pack Quantity	2 PK
Carton Pack Dimensions	9.65 in. x 9.21 in. x 11.80 in. (W x H x D)
Carton Pack Weight	20.461 lbs
Pack Quantity	250 EA
This item is sold by the PK which contains 250 EA

Shipping Info
Can Ship via UPS?	Yes
Can Ship via Air Carrier?	Yes
Hazmat restrictions?	No

Additional Information
Has Energy Star Rating?	No
Is Certified with EPA/CPG?	No
Considered Green (less environmental impact)?	No
Made of Some or All Recycled Materials?	No
Warranty Offered?	No
Underwriter's Laboratory Approval?	No

Item Specifications
Brand	ComplyRight®
Global Product Type	Forms-Insurance
Printer Compatibility	Handwrite Only, Typewriter
Principal Heading(s)	1500 Health Insurance Claim Form
Copy Types	One-Part Carbonless
Form Size	8.5 x 11
Forms Per Page	1
Form Quantity	250
Sheet Size	8.5 x 11
Layout	One Form per Sheet
Paper Color(s)	White
Print and Ruling Color(s)	OCR Red
Pre-Consumer Recycled Content Percent	0%
Post-Consumer Recycled Content Percent	0%
Total Recycled Content Percent	0%

Manufacturer Info
Brand	ComplyRight®
Warranty Offered?	n
Manufacturer Stock No.	CMS12LC250
Staples Equivalent SKU	953639
Retail GTIN (UPC)	00758399422254
Country of Origin	US
UNSPSC Number	00141118
Product ID	7606379