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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




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 " x 9"
Imprint area 1" x 4"


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

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

 

Pricing Medical Forms


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


Carbonless Imprinted Lot Prices
Qty. 250
        500
        1000
        2000
        2500

Carbonless Blank Lot
Qty. 250
        500
        1000
        2000
        2500

____________________


MCF-387-1 Laser
CMS-1500 Claim Form - 1 part


Imprinted Lot Prices
Qty. 250
        500
        1000
        2000
        2500

Blank Lot Prices
Qty. 250
        500
        1000
        2000
        2500

____________________


ENV-9961

Large Claim Form Envelope
with Imprint
Qty. 100
        200
        500
        1000

Large Claim Form Envelope
without imprint
Qty. 100
        200
        500
        1000

____________________


ENV-9960

Small Claim Form Envelope
with Imprint
Qty. 500
        1000
        2000
        3000
        5000

____________________


ENV-9968

Small Claim Form Envelope
with Imprint
Qty. 500
        1000
        2000
        3000
        5000

Small Claim Form Envelope
without Imprint
Qty. 500
        1000
        2000
        3000
        5000