The TOPS CMS-1500 Health Insurance Claim Form is the standard paper claim form used to bill Medicare Fee-For-Service (FFS) Contractors when a paper claim is allowed. It is approved by the National Uniform Claim Committee (NUCC) and the Office of Management and Budget (OMB). Designed for use with a laser printer, the form is printed in red optical character recognition (OCR) ink on 20-lb., white bond paper. It is 8-1/2" x 11" and comes 250 forms per pack. This version (02/12) went into use January 6, 2014.
UPC NO:739197479909
SKU:ADIB00IGJ891Y