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HCFA Forms

HCFA CMS-1500 Item# HCFA L CMS-1500

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Laser/Inkjet  Health Insurance Claim Form (for laser/inkjet printers)
New Form CMS-1500 APPROVED OMB-0938-0999

 
Description: Price Per Sheet:
  • Item: HCFA L / CMS-1500
  • Format: Laser Form CMS-1500
  • Type: Laser One Part
  • Size: 8-1/2" X 11"
  • Weight: 24#
500:    $15.95
1000 $24.95
2500:  $47.90
5000:  $79.90




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HCFA CMS-1500 (1 part) Item# HCFA 1 CMS-1500 - 1 Part

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Continuous Health Insurance Claim Form (for tractor feed printers)
New Form CMS-1500 APPROVED OMB-0938-0999

 
Description: Price Per Sheet:
  • Item: HCFA 1 / CMS-1500
  • Format: Laser Form CMS-1500
  • Type: One Part for pin feed printer
  • Size: 8-1/2" X 11"
  • Weight: 20#
2500:  $47.90
5000:  $79.90




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HCFA CMS-1500 (2 part) Item# HCFA 2 CMS-1500 - 2 Part

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Continuous Health Insurance Claim Form - 2 Part Carbonless
New Form CMS-1500 APPROVED OMB-0938-0999

 
Description: Price Per Set:
  • Item: HCFA 2 / CMS-1500
  • Format: CONTINUOUS (Duplicate)
  • Type: Two Part for pin feed printer
  • Size: 8-1/2" X 11"
  • Weight: White 20# and Canary 15#
1000 $42.99
2000:  $79.99
3000:  $114.95




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Hospital Claim Form UB-04 Item# HC-UB04

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Hospital Claim Form UB-04 - Laser Sheets One Part
 
Description: Price Per Sheet:
  • Item: Hospital Claim Form
  • Format: Laser Form UB-04
  • Type: One Part
  • Size: 8-1/2" X 11"
  • Weight: 24#
500 $15.95
1000 $24.95
2500:  $47.90
5000:  $79.90




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Hospital Claim CONTINUOUS (SINGLE) FORM UB92 Item# HC-CONT-SGL-UB92

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Hospital Claim Form UB-92 - Continuous (One Part)
 
Description: Price Per Sheet:
  • Item: Hospital Claim Form
  • Format: Continuous (Single) Form UB92
  • Type: One Part for pin feed printer
  • Size: 8-1/2" X 11"
  • Weight: 24#
2500:  $47.90
5000:  $79.90




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Hospital Claim CONTINUOUS (Duplicate) FORM UB92 Item# HC-CONT-DUP-UB92

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Hospital Claim Form UB-92 - Continuous (Two Part Carbonless)
 
Description: Price Per Set:
  • Item: HCFA 1 1450 UB92
  • Format: Continuous (Duplicate) Form UB92
  • Type: Two Part for pin feed printer
  • Size: 8-1/2" X 11"
  • Weight: White 20# and Canary 15#
1000:  $42.95
2000:  $79.99
3000:  $114.95




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