CMS-1500 Rev. 08/05; 1-Part Pads

Accommodates reporting of the National Provider Identifier (NPI) number Approved by the National Uniform Claim Committee (NUCC) Better aligned with the electronic HIPAA ASC X12N 837 Non-institutional Transaction Standard Printed on recycled paper Requires carbon paper for duplicates Certified Chain of Custody; Promoting Sustainable Forest Management Size: 8-1⁄2" x 11" Not designed for laser printers. Please see item #'s 14710, CMSLC500, CMSLC250 or CMSLC for laser printers

Product Information

Form Type :

Insurance

Format :

Health Insurance Claim Form

Sheet Size :

8-1/2" x 11"

Form Size :

8-1/2" x 11"

Media Quantity :

500

Binding Type :

Padded

Paper Color :

White

Number of Parts :

1

Carbonless :

Yes

# Up Per Sheet/Page :

1

NCR Paper :

No

Numbered :

No

Holes Punched :

None

Personalization :

No

Security Features :

No

Environmental Information

Certifications & Standards :

SFI Sustainable Forestry Iniative

Miscellaneous

Brand :

Medical Arts Press

Country of Origin :

USA

Weight

Weight :

1.20 lbs. per Pad