Custom Carbonless CMS Forms, 8-1/2" x 11", 100 Sheets per Pad
$28.99
5 pad
(
$0.29/EACH
)
Custom Carbonless CMS Forms, 8-1/2" x 11", 100 Sheets per Pad
Item #:
901-QFW1471901
Model #:
7QGFM1471901
Brand:
Quill Custom Print
4
(1 reviews)
Item #:
901-QFW1471901
Product details
View all details
- 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
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Order in multiples of 5
$28.99
5 pad
(
$0.29/EACH
)
100 EACH = 1 PAD
Custom Carbonless CMS Forms, 8-1/2" x 11", 100 Sheets per Pad
Buy more & save!
Extra 28% off on 25+ units
Qty. savings
Per pad
7%
$26.99
10 pad
15%
$24.59
15 pad
21%
$22.79
20 pad
28%
$20.79
25 + pad
Frequently bought together
+
Item #: 901-QCBC00126
$76.99
1 pack
($0.31/EACH)
78% off
$16.99
20+ pack
($0.07/EACH)
$76.99
+
Total
$248.93
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Description
Accommodates reporting of the NPI number and is approved by the AMA's Council on Medical Services and CMS.
- 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
- 100 sheets per pad, order in quantities of 5 pads
- Printed on recycled paper
- Option to personalize tax ID#, service facility location and provider information
Specifications
# Up Per Sheet/Page
1
Binding Type
Padded
Brand
Quill Custom Print
Carbonless
Yes
Color
White
Customizable
Yes
Form Size
8 1/2" x 11"
Form Type
Medicare
Format
Medical Complaint Form
Holes Punched
No
Lines
Varies
Media Quantity
100
NCR Paper
Yes
Number of Parts
1
Numbered
Yes
Package Quantity
100 per Pad
Personalization
Yes
Security Features
No
Sheet Size
8 1/2" x 11"
