CMS-1500 (02-12) OMB Approved - OMB 0938-1197
CMS 1500 Paper Claim Form (02/12) - 500 SheetsPrint a CMS 1500 PDF on commercially printed claim form.

CMS-1500 Health Insurance Paper Claim Form (02/12)

$20.00$50.00

Meets all Government Printing Office Specifications:
• Commercially Printed on 8.5″ x 11″ paper – 20 # white bond
• Laser cut sheets for use in inkjet or laser printers
• OCR “dropout” red ink for processing on scanner equipment
• Instructions for government/private health programs on back
• Accommodates National Provider Identifier (NPI) reporting
• CMS-1500 (02-12) OMB Approved – OMB 0938-1197
Shrink wrapped in packs of 100, 200 or 500 sheets.

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Product Description

Health Insurance Claim Forms – CMS-1500 (02/12): Health Care Financing Administration ( HCFA ) Form CMS 1500. Designed for processing on high-speed OCR scanning equipment.

Additional Information

Sheets

100, 200, 500

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