Medical Forms

CMS-1500 Claim Forms (Revised 8/05) These forms are authorized by the centers for Medicare and Medicaid Services to meet all insurance claim requirements. The revised CMS-1500 allows for reporting of the National Provider Identifier (NPI) number. Imprint your name, address and I.D. number on the snap-a-part forms.

Envelopes
If you mail just a couple of claim forms, you can choose from ENV-9960 or ENV-9968. The ENV-9968 is designed to make mailing your claim forms faster and more efficient. If you mail several claim forms, choose the 12 ½" x 9" large claim form envelope. Due to new postage regulations, the words "Do Not Bend" have been removed from the large Claim form envelope.

Medical Forms

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MCF-387-2 - Snap-A-Part
MCF-387-1 - Laser
CMS-1500 Claim Form, 81/2" x 11"

ENV-9961
Large Claim Form Envelope, 12 ½" x 9"
Imprint area 1" x 4"

ENV-9960
Small Claim Form Envelope, 4 1/8" x 9 ½"
Imprint area 1 1/8" x 4 3/4"
Window size 7/8" x 4 1/4"

Env-9968
Small Claim Form Envelope, 4 ½" x 9 ½"
Window - 3 7/8" from left side
1 ½" from bottom
Window size 1 1/8" x 4 ¾"

Pricing Medical Forms

MCF-387-2 Snap-A-Part
CMS-1500 Claim Form

Carbonless Imprinted Lot Prices
Parts. 2
Qty. 250-$59.40 | 500-$78.80
     1000-$97.20 | 2000-$185.20
      2500-$23.40

Carbonless Blank Lot Prices
Qty. 250-$39.70 | 500-$56.70
     1000-$69.50 | 2000-$136.60
      2500-$170.20
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MCF-387-1 Part-Laser
CMS-1500 Claim Form

Imprinted Lot Prices
Parts. 1
Qty. 250-$36.70 | 500-$46.30
     1000-$56.40 | 2000-$102.40
      2500-$126.20

Blank Lot Prices
Parts. 1
Qty. 250-$17.00 | 500-$24.30
     1000-$28.60 | 2000-$53.80
      2500-$65.90
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ENV-9961
Large Claim Form Envelope
Qty. 100-$54.90 | 200- $83.50
500-$162.20 | 1000-$262.30

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ENV-9960
Small Claim Form Envelopes
Imprinted Lot Prices
Qty.500-91.90 | 1000-109.40
2000-208.50 | 3000-279.40
5000-425.50

Blank Lot Prices
Qty.500-64.30 | 1000-77.20
2000-140.40 | 3000-199.90
5000-322.10

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ENV-9968
Small Claim Form Envelopes
Imprinted Lot Prices
Qty.500-94.80 | 1000-123.00
2000-235.30 | 3000-346.00
5000-556.80

Blank Lot Prices
Qty.500-75.80 | 1000-98.40
2000-188.30 | 3000-276.80
5000-445.50