60164 a.k.a. 70164, CMS-1500 Laser Insurance Claim Form, Padded & Imprinted

60164 a.k.a. 70164, CMS-1500 Laser Insurance Claim Form, Padded & Imprinted
Click the image above to enlarge
Padded CMS-1500 Laser Insurance Claim Form - Item # 60164

Price

Your Price: $39.00

Choose Options and Quantity

Quantity ? (required) help
Federal Tax I.D. # (required)
Service Facility Information
Service Facility Name (required)
Service Facility Street Address (required)
Service Facility City, State, Zip (required)
Billing Provider Information
Billing Provider Name (required)
Billing Provider Street Address (required)
Billing Provider City, State, Zip (required)
Billing Provider Phone Number (required)
$39 - Insurance Claim Form, Padded & Imprinted
AMA and CMS approved claim form.  Insurance claim laser forms, 100 sheets per pad, single sheet format.  8-1/2" x 11" 1-part laser form on 20# white bond stock, printed in OCR red ink.  Accommodates NPI numbers as mandated by HIPAA. Accepted by most insurance companies.

Production times:
These are located on the left navigation under MORE INFORMATION. 

Return to Top of Page

Recently Viewed Items

Information
Browse By Category