|
2 Part Hand Written CMS 1500 Form. 100 per package. 1 package minimum. Ships in 24 hours.
NEW 2-part CMS 1500 forms for hand written claims.
Sometimes called the HCFA 1500 form. The CMS 1500 form and the HCFA 1500 form are the same form.
New form has place for NPI number. APPROVED OMB 0938-0999 FORM CMS-1500 (08/05). Want samples mailed to you? Click Here. 2 part carbonless (NCR) paper. Provides user with duplicate copy. Top sheet color: white Bottom sheet color: yellow OCR scanable paper. Black and red ink. 100% compatible with UCCI requirements. This is the NEW CMS 1500 (08/05) form mandated by the U.S. Centers for Medicare and Medicaid Services (CMS) to be in use by April 2, 2007, adding the split provider identifier fields for NPI numbers. Minimum order is 100 CMS 1500 forms. 24 hour turnaround. Some information can be pre-imprinted for you. 250 imprinted 2-part handwritten forms are only $45.00, clik here to see. These packages are shipped from our Washington location.To determine shipping cost, select number of packages, add to shipping cart, then enter your zip code in the Shipping Calculator box. It will present you with your shipping options in a pop-up window. Expedited shipping available. 100 per package.
1 package minimum order. |
