Tops TOPS Centers for Medicare and Medicaid Services Forms, 8 1/2 x 11, 250 Forms/Pack
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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. Top sensor bar for microfiche duplication, as required in some states. OCR red ink for scanning. Form Size: 11 x 8 1/2; Forms Per Page: 1; Form Quantity: 250; Principal Heading(s): 1500 Health Insurance Claim Form.
*Orders received after 2pm EST may be delayed by one business day. Most products are shipped with UPS Ground and take 1-4 business days to arrive.
Buy 2+ packs
$33.95/packSave 17.09%
Buy 4+ packs
$29.94/packSave 26.89%
Buy 6+ packs
$28.95/packSave 29.30%
Not eligible for return
Due to the nature of this product, we are currently unable to accept returns.
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