TOPS™ Centers for Medicare and Medicaid Services (CMS) Forms

4 item variations by TOPS™
FREE shipping on orders over $75!
starting at $16.69 USD / PK
bulk from $12.60 / PK

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Product Variations

TOP50135RV Thumbnail
8 1/2 x 11, 250 Forms/Pack
Item #: TOP50135RV
BUY EACH
$16.69 /PK
DELIVERY: 1 - 2 business days
Stock: 443
BUY BULK
$12.60 /PK
Minimum buy 24, then 8+
DELIVERY: 5 - 7 business days
TOP50126RV Thumbnail
8 1/2 x 11, 500 Forms/Pack
Item #: TOP50126RV
BUY EACH
$28.93 /PK
DELIVERY: 1 - 2 business days
Stock: 2,768
BUY BULK
$22.85 /PK
Minimum buy 15, then 5+
DELIVERY: 5 - 7 business days
TOP50122RV Thumbnail
3000 Forms/Carton
Item #: TOP50122RV
BUY EACH
$116.87 /CT
DELIVERY: 1 - 2 business days
Stock: 39
BUY BULK
$95.77 /CT
Minimum buy 3
DELIVERY: 5 - 7 business days
TOP50124RV Thumbnail
Two-Part, 1500 Forms
Item #: TOP50124RV
BUY EACH
$133.17 /CT
DELIVERY: 1 - 2 business days
Stock: 32
BUY BULK
$105.21 /CT
Minimum buy 3
DELIVERY: 5 - 7 business days

Product Details

TOPS™ Centers for Medicare and Medicaid Services (CMS) 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
Global Product Type Forms-Insurance
Form Size 8 1/2 x 11
Forms Per Page 1
Form Quantity Available in: 250, 500, 1500 or 3000
Principal Heading(s) 1500 Health Insurance Claim Form
Layout One Form per Sheet
Printer Compatibility Available in: Dot Matrix or Laser
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%
Special Features Available in: Carbonless Duplicate, Continuous Form or For Laser Printers
Brand TOPS™
Copy Types Two-Part Carbonless
Punching Dot Matrix Pin Feed Holes
Footnote 1 Carbonless Duplicate
Manufacturer Info
Brand TOPS™  (website)
Brand Contact 800-282-7261

Customer Questions and Answers

 
Your question has been received, and we will work to answer it quickly! If you need immediate assistance, please call us at 1-866-501-6055.

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Document printed / saved on 10/20/2018. Prices subject to change.