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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.
Dimensions / Specifications | |
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Unit of Measure | PK |
Item Dimensions | 8.50 in. x 2.20 in. x 11.00 in. (W x H x D) |
Item Weight | 5.193 lbs |
Carton Pack Quantity | 5 PK |
Carton Pack Dimensions | 9.00 in. x 11.38 in. x 11.38 in. (W x H x D) |
Carton Pack Weight | 27.500 lbs |
Pack Quantity | 500 50 |
This item is sold by the PK which contains 500 50 |
Shipping Info | |
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Can Ship via UPS? | Yes |
Can Ship via Air Carrier? | Yes |
Hazmat restrictions? | No |
Additional Information | |
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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 | |
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Brand | TOPS |
Form Type Details | CMS-1500 |
Global Product Type | Insurance Forms |
Dated/Undated | Undated |
Forms Per Page | 1 |
Form Size | 8.5 x 11 |
Format Indicator | Unbound |
Form Quantity (Total) | 500 |
Copy Types | One-Part (No Copies) |
Principal Heading(s) | 1500 Health Insurance Claim Form |
Paper Color(s) | White |
Color Family | White |
Printer Compatibility | Laser |
Paper Stock | 20 lb Bond |
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% |
Special Features | Laser Printer Compatible |
Manufacturer Info | |
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Brand | TOPS (website) |
Brand Contact | 800-282-7261 |
Warranty Offered? | n |
Manufacturer Stock No. | 50126RV |
Staples Equivalent SKU | 309934 |
Quill Equivalent SKU | 50126RV |
Office Max Equivalent SKU | 25324845 |
Office Depot Equivalent SKU | 561809 |
Retail GTIN (UPC) | 00025932512605 |
Country of Origin | US |
UNSPSC Number | 14111806 |
Product ID | 9472515 |