CMS-1500 Rev. 08/05; 1-Part Self Duplicating 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 One-part self-duplicating (carbonless) pads Option to personalize tax ID#, service facility location and provider information Certified Chain of Custody; Promoting Sustainable Forest Management Size: 8-1⁄2" x 11"

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 :

Yes

Numbered :

No

Holes Punched :

None

Personalization :

No

Security Features :

No

Environmental Information

Certifications & Standards :

SFI Sustainable Forestry Iniative

Miscellaneous

Brand Name :

Medical Arts Press

Country of Origin :

USA

Weight

Weight :

1.20 lbs. per Pad