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CMS-1500 Health Insurance Claim Form One-Part No Copies 8.5x11 100Ct 650657

CMS-1500 Health Insurance Claim Form One-Part No Copies 8.5x11 100Ct 650657
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ComplyRight® CMS-1500 Health Insurance Claim Form

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. Form Type Details: CMS-1500; Dated/Undated: Undated; Forms Per Page: 1; Form Size: 8.5 x 11.

  • Global Product Type: Insurance Forms
  • Form Type Details: CMS-1500
  • Dated/Undated: Undated
  • Forms Per Page: 1
  • Form Size: 8.5 x 11
  • Sheet Size: 8.5 x 11
  • Format Indicator: Unbound
  • Form Quantity (Total): 100
  • Copy Types: One-Part (No Copies)
  • Principal Heading(s): 1500 Health Insurance Claim Form
  • Paper Color(s): White
  • Color Family: White
  • Print and Ruling Color(s): OCR Red
  • Product Biodegradability in Days: 0
  • Pre-Consumer Recycled Content Percent: 0%
  • Post-Consumer Recycled Content Percent: 0%
  • Total Recycled Content Percent: 0%

WARNING: This product can expose you to chemicals including Di(2-ethylhexyl)phthalate (DEHP), which is known to the State of California to cause cancer and birth defects or other reproductive harm. For more information, go to www.P65Warnings.ca.gov.
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Shipping Restrictions
  • This item cannot be shipped to PO Boxes.
  • This item can be shipped only within the U.S.


  • UPC: 015171105096 
  • Mfr's Part #: 650657