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Product Details
Meet billing requirements for Medicare Part B. Easy-to-read forms with crisp, clean text help ensure faster claims processing. Paper, layout and ink comply with CMS standards and requirements. Layout includes all 02/12 NUCC revisions and is a direct replacement for the previous 08/05 version. Printed in scannable, OCR "dropout" red ink.
Additional Information
- Part #: TFP650657
- MPN: 650657
- UPC: 015171105096
- UNSPC: 14111806
- Meet billing requirements for Medicare Part B.
- Easy-to-read forms for faster claims processing.
- Comply with CMS standards and requirements for paper, layout and ink.
- Printed in scannable, dropout OCR red ink.
- Include all 02/12 NUCC revisions, replacing the previous 08/05 version.
Brand | ComplyRight |
---|---|
Form Size | 8.5 x 11 |
Forms Per Page | 1 |
Form Quantity | 100 |
Sheet Size | 8.5 x 11 |
Principal Heading(s) | 1500 Health Insurance Claim Form |
Layout | One Form per Sheet |
Copy Types | One-Part Carbonless |
Paper Color(s) | White |
Print and Ruling Color(s) | OCR Red |
Pre-Consumer Recycled Content Percent | 0% |
Post-Consumer Recycled Content Percent | 0% |
Total Recycled Content Percent | 0% |
Country of Origin | US |
Prop65 | No |
Unit of Measure | PK |
Last Updated | 2/4/2022 |