60151X CMS 1500 Two Part Carbonless Insurance Claim Form 0212 8 1/2 x 11" QTY 250
$79.41
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60151X CMS 1500 Two Part Carbonless Insurance Claim Form 0212 Size: 8 1/2 x 11"Speed third-party billing and manage your cash flow with this AMA and CMS approved claim form. Includes all updates in the 02/12 version approved by the NUCC (National Uniform Claim Committee) Convenient and easy to use! 2-part form on 20# /15# self-duplicating Printed in OCR red ink. Accommodates NPI numbers as mandated by HIPAA. Accepted by most health insurance companies. 250 per pack.
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$79.41
(+$5.25)