HCFA FORMS: Laser (WCMS-1500-CS-12) Case of 2,500

This is the REVISED form (see changes)

Health Insurance Claim Forms are United States government approved to serve federal programs and private insurers as a universal claim form

• Accommodates reporting of National Provider Identifier (NPI) numbers
• Approved by the National Uniform Claim Committee and CMS; aligned with electronic HIPAA ASC X12N 837 Non-Institutional Transaction Standard
• Forms are for use with laser printers
• Size: 8 1/2" x 11"

PLEASE CALL TO ORDER DUE TO SHIPPING CHANGES IN OUR SYSTEM.