Our HCFA-1500 & UB-92 (HCFA-1450) forms are used for submitting Medicare, insurance & hospital related charges. Both forms have the special Red ink for OCR scanning. Both forms are available in pinfeed or laser format. Prices shown are for one (1) box.
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HCFA INSURANCE FORM-CUT SHEET
79109NPI
CMS-1500 Version 08/05 Laser Cut Sheet Format - 1000 per Box
Laser cut sheet format. Printed in OCR red ink on 20 lb laser paper. No barcode.
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HCFA INSURANCE FORM-CUT SHEET (BULK)
79259NPI
CMS-1500 Version 08/05 Laser Cut Sheet Format - 2500 per Box
Laser cut sheet format. Printed in OCR red ink on 20 lb laser paper.
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HCFA INSURANCE FORM-PINFEED
79106NPI
CMS-1500 Version 08/05 1-Part Continuous Pinfeed Format Form - 1000 per Box
Single part continuous pinfeed format. Printed in OCR red ink on 20 lb bond paper.
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HCFA INSURANCE FORM-PINFEED (2PART)
79120NPI
CMS-1500 Version 08/05 2-Part Continuous Pinfeed Format Form - 1000 per Box
2-Part White / Canary Continuous Pinfeed format. Printed in OCR red ink on 20 lb bond.
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HCFA INSURANCE FORM-PINFEED (BULK)
79256NPI
CMS-1500 Version 08/05 1-Part Continuous Pinfeed Format Form - 2500 per Box
Single part continuous pinfeed format. Printed in OCR red ink on 20 lb bond paper.
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HCFA INSURANCE SIGNATURE LABEL
7891HL
PKG/375 HCFA INSURANCE SIGNATURE RELEASE LABEL
Save time by having patient sign several insurance release labels on their first visit. They can be used for subsequent claims as needed. Compatible with HCFA-1500 (CMS) forms. 375 labels per package. White.
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INSURANCE CLAIM FORM ENVELOPE
HC10RG
CTN/500 ENVELOPE,REG SEAL,WINDOW,INS CLAIM FORM
The window placement is specifically designed to have the insurance carrier’s name and address show through the window. Simply fold the claim form so name and address show through window. Regular-Seal envelope with interior security tint. Right hand window. Overall size 9-1/2” W x 4-1/8” H. 500 envelopes per carton.
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INSURANCE CLAIM FORM ENVELOPE
HC10SS
CTN/500 ENVELOPE,SELF SEAL,WINDOW,INS CLAIM FORM
The window placement is specifically designed to have the insurance carrier’s name and address show through the window. Simply fold the claim form so name and address show through window. Self-Seal envelope with interior security tint. Right hand window. Overall size 9-1/2” W x 4-1/8” H. 500 envelopes per carton.
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INSURANCE SUBMISSION ENVELOPE
HC912
PKG/100 ENVELOPE,INS SUBMISSION
Jumbo insurance envelope is designed to accommodate up to 50 insurance claims to the same carrier without having to fold forms. Regular-Seal left flap. 100 envelopes per package.
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PRIVACY SIGN-IN SHEETS-BLUE
18228
Patient Sign-In Sheet #1-23 Lt-Blue
Meet the needs of patient privacy expectations. Patients fill in information line on removable strip. Carbon sheet transfers names to back sheet so other patients do not see the previous patient's information. Overall size 8-1/2" W x 11" H. 250 forms per package.
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PRIVACY SIGN-IN SHEETS-FISH
17017
ColorForm Patient Sign-In Sheet #1-23 Lt-Blue Fish
Meet the needs of patient privacy expectations. Patients fill in information line on removable strip. Carbon sheet transfers names to back sheet so other patients do not see the previous patient's information. Overall size 8-1/2" W x 11" H. 100 forms per package.
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PRIVACY SIGN-IN SHEETS-GREEN
18229
Patient Sign-In Sheet #1-23 Lt-Green
Meet the needs of patient privacy expectations. Patients fill in information line on removable strip. Carbon sheet transfers names to back sheet so other patients do not see the previous patient's information. Overall size 8-1/2" W x 11" H. 250 forms per package.
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PRIVACY SIGN-IN SHEETS-SALMON
14037
Patient Sign-In Sheet #1-23 Salmon
Meet the needs of patient privacy expectations. Patients fill in information line on removable strip. Carbon sheet transfers names to back sheet so other patients do not see the previous patient's information. Overall size 8-1/2" W x 11" H. 250 forms per package.
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PRIVACY SIGN-IN SHEETS-SMILE
17008
ColorForm Patient Sign-In Sheet #1-23 Smile
Meet the needs of patient privacy expectations. Patients fill in information line on removable strip. Carbon sheet transfers names to back sheet so other patients do not see the previous patient's information. Overall size 8-1/2" W x 11" H. 100 forms per package.
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PRIVACY SIGN-IN SHEETS-TOOTHBRUSH
17014
ColorForm Patient Sign-In Sheet #1-23 Toothbrushes
Meet the needs for patient privacy expectations. Patients fill in information line on removable strip. Carbon sheet transfers names to back sheet so other patients do not see the previous patient's information. Overall size 8-1/2" W x 11" H. 100 forms per package.
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