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Expedite Medicare, Medicaid or private insurance benefits. NUCC, CMS and AMA approved format. (02/12) version. Printed front and back in red OCR ink for scanning.
TOP50124RV
33 Items
Data sheet
- Special Features
- Carbonless Duplicate
- Punching
- Dot Matrix Pin Feed Holes
- Footnote 1
- Carbonless Duplicate
- Paper Color(s)
- White
- Global Product Type
- Forms-Insurance
- Pre-Consumer Recycled Content Percent
- 0%
- Post-Consumer Recycled Content Percent
- 0%
- Total Recycled Content Percent
- 0%
- Form Size
- 8 1/2 x 11
- Forms Per Page
- 1
- Form Quantity
- 1500
- Principal Heading(s)
- 1500 Health Insurance Claim Form
- Layout
- One Form per Sheet
- Paper Stock
- 20-lb.
- Print and Ruling Color(s)
- OCR Red
- Copy Types
- Two-Part Carbonless
- Printer Compatibility
- Dot Matrix
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Expedite Medicare, Medicaid or private insurance benefits. NUCC, CMS and AMA approved format. (02/12) version. Printed front and back in red OCR ink for scanning.