Page 2 of ingenix insurance directory
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ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
Item #: 901-24614845
Designed for hospitals to file a medical claim with the patient's insurance carrier
One-part health insurance forms
Printed with OCR dropout red ink on white paper
Medical Arts Press® Standard Preprinted Chart Divider Tabs; Insurance, Red
Item #: 901-30216
Titles are printed in black ink on white stock with a color-coded edge
Pressure-sensitive tabs are protected by clear laminate
5 tabs per strip
Custom 4-1/2" x 9" Insurance Claim Right Window Standard Envelopes with Security Tint, 24# White Wove, 1 Standard Ink, 250/Pack
Item #: 901-QCENV00862
4-1/2" x 9" Envelopes with Security Tint, Gum Seal
24# White Wove Stock with Security Tint, Flat Ink
Window size is 4-1/2" x 1-1/4"; window is 1/2" from right and 1-1/2" from bottom
Custom 4-1/2" x 9" Insurance Claim Self Seal Right Window Envelopes with Security Tint, 24# Blue Wove, 1 Standard Ink, 250/Pack
Item #: 901-QCENV00725
4-1/2" x 9" Envelopes, Self Seal with Security Tint
24# Blue Wove Stock with Security Tint, Flat Ink
Window is 4-1/4" x 1-1/2", 1-1/4" from bottom and 3/4" from right side
Patient Insurance Labels, Insurance Paid/You Owe, Fluorescent Pink, 1-3/4x3-1/4", 500 Labels
Item #: 901-35385
500 Fluorescent Pink "Insurance Paid/You Owe" labels per pack
Pressure-sensitive for easy application
Size: 3-1/4" x 1-3/4"
Medical Arts Press® Position 6 Colored End-Tab Chart Dividers, Insurance, Blue, 100/Pack (56828)
Item #: 901-56828
Sturdy 90 lb. manila dividers with mylar reinforced tabs are printed on both sides
100 per pack
Each tab is 1-7/8" wide
Insurance Chart File Medical Labels, Medicaid, Fluorescent Pink, 5/16x1-1/4", 500 Labels
Item #: 901-34712
500 Fluorescent Pink "Medicaid" labels per roll
Pressure-sensitive for easy application
Size: 1-1/4" x 5/16"
Quill Brand® 250/Pack Health Insurance Letter Rate Claim Window Envelope, 6" x 11-1/2", 24# White Wove, No Imprint
Item #: 901-QCENV00937
6" x 11-1/2" Envelopes, Gum Seal
24# White Wove Stock, Blank
Window size is 4-1/2" x 1-1/4"; when the flap is at the top the window is 1/2" from top and 4" from left
Medical Arts Press Dental Registration Forms Featuring Updates Section; Sky Blue, Spanish (20743)
Item #: 901-20743
Collects printed name and relationship to patient
Medication list requests correlating diagnosis
Screens for artificial heart valves, artificial joints, heart
Medical Arts Press® Position 6 Colored Side-Tab Chart Dividers, Insurance, Blue, 100/Pack (56791)
Item #: 901-56791
Sturdy 90 lb. manila dividers with mylar reinforced tabs are printed on both sides
100 per pack
Each tab is 1-7/8" wide
Custom 4-1/2" x 9" Insurance Claim Right Window Self Seal Envelopes with Security Tint, 24# White Wove, 1 Standard Ink, 250/Pack
Item #: 901-QCENV00856
4-1/2" x 9" Envelopes with Security Tint, Self Seal
24# White Wove Stock with Security Tint, Flat Ink
Window size is 4-1/2" x 1-1/2"; the window is 1/2" from the right and 1-1/2" from bottom
Medical Arts Press Registration Forms without Updates Section ; Brush Silhouette
Item #: 901-21786
Comprehensive form gathers complete insurance information, making it easier for you to process claims
Silhouetted toothbrush design welcomes patients
Printed in 1-color on two sides on 24-lb. white bond paper
Custom 1-Sided Insurance Registration Forms, 8-1/2" x 11", 250 Sheets per Pack
Item #: 901-QFN105011R
For use in patient charts
8-1/2" W x 11" L
White 20# text stock; printed in black ink
Medical Arts Press® 6-Tab Chart Medical Indexes, End Tab, 65 Per box
Item #: 901-33157
Pre-Affixed Color-Coded Tabs Feature The Most Popular Titles Plus 1 Write-on Blank, Erasable Tab
Tab Titles Include: History and Physical, Progress notes, Lab/X-Ray, Insurance, Miscellaneous and Blank
Tabs Are Printed with The Same Title On Both Sides and Reinforced with Tear-Proof Mylar
$110.99
1-2 box
($1.71/EACH)
Save 9%
$100.99
3+ box
($1.55/EACH)
ComplyRight Employee Benefits & Insurance Records Organizer, Pack of 25 (A0309)
Item #: 901-2549009
Package of 25 folders
Size: 11.75" x 9.5"
Capture important personnel information right on the folder
Patient Insurance Labels, Insurance Paid Its Share, Fluorescent Red, 7/8x1-1/2", 500 Labels
Item #: 901-34443
Each label measures 7/8"H x 1 1/2"W
Fluorescent red, red (label)
Legend: Insurance Paid Its Share
Insurance Chart File Medical Labels, Preauthorization Required, Fl Chartreuse, 7/8x1-1/2", 500 Lbls
Item #: 901-39626
500 Fluorescent Chartreuse "Preauthorization Required" labels per roll
Pressure-sensitive for easy application
Size: 1-1/2" x 7/8"
Insurance Chart File Medical Labels, HMO, Fluorescent Red, 7/8x1-1/2", 500 Labels
Item #: 901-34294
Fluorescent red
Legend: HMO
Material: Label stock paper
Quality Park Health Claim Insurance Self Seal Catalog Envelopes, 9" x 12.5", White Wove, 100/Box (QUA54692)
Item #: 901-54692
Window envelopes for medicare form HCFA-1508 and other standard healthcare insurance forms
These durable claim form envelopes are made of 28 lbs. white wove stock
Dimensions: 9"L x 12.5"H
Medical Arts Press® 6-Tab Chart Medical Indexes, Side Tab, 65 Per Box
Item #: 901-33159
Pre-Affixed Color-Coded Tabs Feature The Most Popular Titles Plus 1 Write-on Blank, Erasable Tab
Tab Titles Include: History and Physical, Progress notes, Lab/X-Ray, Insurance, Miscellaneous and Blank
Tabs Are Printed with The Same Title On Both Sides and Reinforced with Tear-Proof Mylar
Custom 4-1/2" x 9" Insurance Claim Left Window Envelopes with Security Tint, 24# White Wove, 2 Standard Inks, 250 / Pack
Item #: 901-QCENV00715
4-1/2" x 9" Envelopes, Gum Seal with Security Tint
24# White Wove Stock with Security Tint, Flat Ink
Window is 4-1/4" x 1-1/2", 1-1/4" from bottom and 3/4" from left side
Custom 4-1/2"x9" Insurance Claim Peel and Seal Right Window Envelopes with Security Tint, 24# White Wove, 2 Std Inks, 250/Pack
Item #: 901-QCENV00721
4-1/2" x 9" Envelopes, Peel and Seal with Security Tint
24# White Wove Stock with Security Tint, Flat Ink
Window is 4-1/4" x 1-1/8 ", 1-1/4" from bottom and 5/8" from right
Insurance Carrier Collection Labels, Primary EOB Attached, Fl Green, 7/8x1-1/2", 250 Labels
Item #: 901-39227T
Each label measures 7/8"H x 1 1/2"W
Fluorescent green, green (label)
Legend: Primary EOB Attached
Custom X-Ray I.D. Cards, 5" x 3", 250 Cards per Pack
Item #: 901-QFN101XID1R
For use on X-Rays to identify patient and doctor
5" W x 3" L
White 65# cover stock, printed in black ink