Centers for Medicare and Medicaid Services Forms, 8 1/2 x 11, 250 Forms/Pack
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Specifications

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Model No.: 50135R
Alternate Model Numbers: TOP50135RV 50135R
UPC: 025932513503
Ship Weight (lbs): 2.660
Care Warehouse SKU: 2111363 (71)
Manufacturer: TOPS BUSINESS FORMS

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Centers for Medicare and Medicaid Services Forms, 8 1/2 x 11, 250 Forms/Pack / PK

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Item Description

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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. Top sensor bar for microfiche duplication, as required in some states. OCR red ink for scanning. Form Size: 11 x 8 1/2; Forms Per Page: 1; Form Quantity: 250; Principal Heading(s): 1500 Health Insurance Claim Form.


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This product is made in US

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