نموذج مطالبة التأمين VER 02/12 ، وايت ، 2500 ورقة (CMS-1500)
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مميزات خاصة
- Version 02/12, 2,500 Sheets
- Accommodates reporting of the National Provider Identifier (NPI) number
- Jam-free performance Paper are printed in OCR-scannable red ink
- All forms are government approved CMS-1500 to serve federal programs and private insurers as a universal claim form.
- Approved OMB 0938-1197
وصف
1 Part Laser (2,500 Single Sheets - for Laser/Inkjet Printers). 02/12 Version. Factory Sealed
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