close popup
Skip to main content
Skip to footer
quill points image
Earn QPoints + $17.99 5-Ream Paper. $4.99 First-Year Membership
Close

CMS Form 1500 Rev. 02/12 Claim Form, 8-1/2" x 11", 1-Part, 100 Forms, Personalized (14719)

See pricing info, deals and product reviews for CMS Form 1500 Rev. 02/12 Claim Form, 8-1/2" x 11", 1-Part, 100 Forms, Personalized (14719) at Quill.com. Order online today and get fast, free shipping for your business.
Item #: 901-14719
  Model #: 14719
Brand: Medical Arts Press
CMS Form 1500 Rev. 02/12 Claim Form, 8-1/2 x 11, 1-Part, 100 Forms, Personalized (14719)
$16.99 Pad
100 EACH = 1 PAD
Order in multiples of 5
Buy more & save!
Qty 5 10-15 20+
Price $16.99 $15.99 $14.99
Price per each: $0.17 $0.16 $0.15
Delivery Date:

Enter Zip Code
Parcel
Description
  • 1 part form for use by all medical facilities/entities billing insurance companies, Medicaid and Medicare
  • Laser cut and printed on white paper, carbonless
  • Includes 100 forms
  • Size: 8-1/2" x 11"
  • Accommodates reporting of the National Provider Identifier (NPI) number
  • Approved by the AMA’s Council on Medical Services and CMS
  • Better aligned with the electronic HIPAA ASC X12N 837 Non-institutional Transaction Standard
  • Printed on recycled paper
  • Carbon paper is required for duplicates
  • Option to personalize tax ID#, service facility location and provider information
Specifications
Recycled : Yes Brand : Medical Arts Press Customizable : Yes
Weight : 1.20 lbs. per Pad

Frequently Bought Together

Customers also viewed

Customers also bought

NewsWeek website
loadingLoading...