Centers for Medicare and Medicaid Services Forms, Two-Part, 1500 Forms

Item #: TOP50124RV
by TOPS™
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Product Details

Centers for Medicare and Medicaid Services Forms, Two-Part, 1500 Forms

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.


Product Specifications

Item Specifications
Brand TOPS™
Global Product Type Forms-Insurance
Form Size 8 1/2 x 11
Forms Per Page 1
Form Quantity 1500
Principal Heading(s) 1500 Health Insurance Claim Form
Layout One Form per Sheet
Copy Types Two-Part Carbonless
Punching Dot Matrix Pin Feed Holes
Printer Compatibility Dot Matrix
Paper Stock 20-lb.
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%
Footnote 1 Carbonless Duplicate
Special Features Carbonless Duplicate

Dimensions / Specifications
Unit of Measure CT
Item Weight 31.000 lbs
Ships via UPS? y
Carton Pack Quantity 1500 ST
This item is sold by the CT which contains 1500 ST

Catalog Information
Catalog Page No.'s EVERYTHING FOR THE WORKPLACE 2014: Page 967
EVERYTHING FOR THE WORKPLACE 2015: Page 983
EVERYTHING FOR THE WORKPLACE NON-VIRTUAL 2015: Page 983
EVERYTHING FOR THE WORKPLACE NON-VIRTUAL 2016: Page 979
EVERYTHING FOR THE WORKPLACE NON-VIRTUAL 2017: Page 911
Manufacturer Info
Brand TOPS™  (website)
Brand Contact 800-282-7261
Manufacturer Stock No. 50124R
Retail UPC 025932512407
Country of Origin US
Tariff (Inbound) Code
UNSPSC Number 14111806
Meets ANSI/BIFMA? 025932512407
OTS Product ID 9472549

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Document printed / saved on 12/16/2017. Prices subject to change.