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Custom 2-Part Snapset CMS Forms, 8-1/2" x 11", 500 Sets per Pack
Item #: 901-QFW1471701
Snapset form for use by all medical facilities for billing insurance companies, Medicaid and Medicare; aligned with the electronic HIPAA ASC X12N 837 Non-institutional Transaction Standard
8-1/2" W x 11" L
2-part, white/canary, carbonless
TOPS Centers for Medicare and Medicaid Services Forms, 8-1/2" x 11", 250/Pack (50135RV)
Item #: 901-2408453
Item #: 901-2408453
CMS-1500 claim forms (formerly known as HCFA-1500 claim forms) expedite Medicare, Medicaid or private insurance benefits
Top sensor bar for microfiche duplication, as required in some states
OCR red ink for scanning
$26.09
Per pack
($0.10/EACH)
Adams CMS-1500 1 Part Health Insurance Claims, 100/Pack (ABF CMS1500L1V)
Item #: 901-486075
Item #: 901-486075
Satisfy record keeping requirements with these health insurance claim forms
Number of parts: 1
Contains 100 forms per package
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 1,000 (CMS12LC1)
Item #: 901-CMS12LC1
Item #: 901-CMS12LC1
Includes QR code identifier at the top of the form that supports and aligns with Industry scanning systems
Printed with OCR "dropout" red ink on 20lb. paper (per government regulations)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
ComplyRight CMS-1500 Health Insurance Claims, 2500/Pack (CMS12LC)
Item #: 901-125557
Item #: 901-125557
Includes QR code identifier at the top of the form that supports and aligns with Industry scanning systems
Printed with OCR "dropout" red ink on 20lb. paper (per government regulations)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
Item #: 901-CMS12LC250
Item #: 901-CMS12LC250
Approved by the National Uniform Claim Committee (NUCC); HIPAA compliant
This form was revised to align the paper form with some of the changes in the electronic healthcare claims: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1)
The most significant change was the addition of 8 diagnosis codes in field 21
$47.29
Per box
($0.19/EACH)
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 500 (CMS12LC500)
Item #: 901-CMS12LC500
Item #: 901-CMS12LC500
Includes QR code identifier at the top of the form that supports and aligns with Industry scanning systems
Printed with OCR "dropout" red ink on 20lb. paper (per government regulations)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
Custom Carbonless CMS Forms, 8-1/2" x 11", 100 Sheets per Pad
Item #: 901-QFW1471901
For use by all medical facilities for billing insurance companies, Medicaid and Medicare; aligned with the electronic HIPAA ASC X12N 837 Non-institutional Transaction Standard
8-1/2" W x 11" L
1-part, white, carbonless; carbon paper is required for duplicates
TOPS CMS-1500 Health Insurance Claims, 500/Pack (TOP 50126RV)
Item #: 901-309934
Item #: 901-309934
Satisfy record keeping requirements with these health insurance claim forms
Number of parts: 1
Contains 500 forms per package
$52.59
Per pack
TFP UB-04 CMS-1450 1-Part Health Insurance Claims, 2500/Carton (UB04LC)
Item #: 901-519727
Item #: 901-519727
Designed for hospitals to file a medical claim with the patient's insurance carrier
One-part health insurance forms
Contains 2500 forms per carton
Custom Carbonless 2-Part Forms, 5-1/2" x 8-1/2", 250 Sets per Pack
Item #: 901-QFNM2P1S1R
Design your own forms using your own artwork
5-1/2" W x 8-1/2" L
2-part, white/canary, carbonless
Custom Carbonless 2-Part Forms, 5-1/2" x 8-1/2", 2 Standard Inks, 250 Sets per Pack
Item #: 901-QFNM2P1S2R
Design your own forms using your own artwork
5-1/2" W x 8-1/2" L
2-part, white/canary, carbonless
Custom Carbonless 2-Part Forms, 8-1/2" x 11", 250 Sets per Pack
Item #: 901-QFNL2P1S1R
Design your own forms using your own artwork
8-1/2" W x 11" L
2-part, white/canary, carbonless
Custom Carbonless 2-Part Forms, 8-1/2" x 11", 2 Standard Inks, 250 Sets per Pack
Item #: 901-QFNL2P1S2R
Design your own forms using your own artwork
8-1/2" W x 11" L
2-part, white/canary, carbonless
ComplyRight CMS-1500 Jumbo Health Care Billing Envelope, 500/Pack (1500LR500)
Item #: 901-24581404
Item #: 901-24581404
This CMS-1500 jumbo health care billing envelope helps reduce processing delays
500 envelopes per box
Form size: 9" x 12.5"
Custom Full Color 2-Part Carbonless Forms, 5-1/2" x 8-1/2", 250 Sets per Pack
Item #: 901-QFN21NAVQ
Design your own forms using your own artwork
5-1/2" W x 8-1/2" L
2-part, white/canary, carbonless
Custom Carbonless 3-Part Forms, 4-1/2" x 5-1/2", 1000 Sets per Pack
Item #: 901-QFN132151R
Design your own forms using your own artwork
4-1/2" W x 5-1/2" L
3-part, white/canary/pink, carbonless
Custom 2-Part Numbered Charge Slip Forms, 8-1/2" x 11", 1000 Sets per Pack
Item #: 901-QFW1053801
For internal use in veterinary offices
8-1/2" W x 11" L
2-part, white/canary, carbonless; pre-printed in black and blue ink
Custom Classic Small Sales Slips 2 Parts, 1 Color Printing, 4 1/4" x 7", 500/Pack
Item #: 901-D802
Consecutive numbering available
Convenient: Snapset Format
Consecutive numbering: These forms come with the option to have consecutive numbering printed on them
Custom 2-Part Charge Slip Forms, 8-1/2" x 11", 1000 Sets per Pack
Item #: 901-QFW1054401
For internal use in veterinary offices
8-1/2" W x 11" L
2-part, white/canary, carbonless; pre-printed in black and blue ink
Custom Carbonless 2-Part Examination Report Forms, 4" x 5-1/2", 50 Sets per Pad
Item #: 901-QFN131141R
Use to provide costs and services to patients and for use in patient charts
4" W x 5-1/2" L
2-part, white/canary, carbonless; printed in black ink
Custom Register Form, Classic Design, Large Format, NO CASH RETURNS, 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D610SW2B
Multiple layout options: Available in your choice of 3 layouts of special wording - Layout A: All Sales Final, Layout B: No Cash Returns, Layout C: Custom Message
Compatible with our registers
Consecutive numbering: These forms come with the option to have consecutive numbering printed on them
Custom Register Form, Classic Design, Lg Format, Your Custom Wording, 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D610SW2C
Multiple layout options: Available in your choice of 3 layouts of special wording - Layout A: All Sales Final, Layout B: No Cash Returns, Layout C: Custom Message
Compatible with our registers
Consecutive numbering: These forms come with the option to have consecutive numbering printed on them
Custom Register Forms, Classic, Cash & Charge 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D158142
Die cut holes fit most standard registers
Includes personalization up to 4 lines
Imprint Color: Red
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