CMS-1500 Rev. 08/05; 2-Part Snapset, 500/Box

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 Two-part, self-duplicating (white/yellow) on carbonless paper Certified Chain of Custody; Promoting Sustainable Forest Management Size: 8-1⁄2" x 11" To personalize tax ID#, service facility location and provider information, order item #14717. Please call toll free 1-800-328-2179

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 :

Perforated

Paper Color :

WhiteYellow

Number of Parts :

2

Carbonless :

Yes

# Up Per Sheet/Page :

1

NCR Paper :

Yes

Numbered :

No

Holes Punched :

None

Personalization :

No

Security Features :

No

Miscellaneous

Weight :

11.00 lbs. per Box

Brand :

Medical Arts Press

Country of Origin :

USA

Weight

Weight :

11.00 lbs. per Box