UB-92 / CMS-1450 / HCFA-1450  CLAIM FORMS
AVAILABLE IN EITHER LASER-CUT SHEETS OR ONE TO FOUR-PART CONTINUOUS (TRACTOR-FEED) FORMS ON HIGH-QUALITY PAPER TO GOVERNMENT STANDARDS.

LASER CUT

CONTINUOUS

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NOTE:  WE ARE NOT ACCEPTING RETURNS ON OLD VERSION UB-92/HCFA 1450/CMS-1450 FORMS

Description

Quantity/Case

Price/Case

Secure Order

Laser, Ink Jet, Bubble Jet Printer Compatible
UB-92/HCFA 1450/CMS-1450 FORMS

2500

$35.00

TO ORDER CALL US
 TOLL FREE AT:
 1-877-840-1500

1 Part Continuous
UB-92/HCFA 1450/CMS-1450 FORMS

2500

$35.00

TO ORDER CALL US
 TOLL FREE AT:
 1-877-840-1500

2 Part Continuous
UB-92/HCFA 1450/CMS-1450 FORMS

1000

$42.95

TO ORDER CALL US
 TOLL FREE AT:
 1-877-840-1500

3 Part Continuous
UB-92/HCFA 1450/CMS-1450 FORMS

500

$35.00

TO ORDER CALL US
 TOLL FREE AT:
 1-877-840-1500

4 Part Continuous
UB-92/HCFA 1450/CMS-1450 FORMS

500

$43.10

TO ORDER CALL US
 TOLL FREE AT:
 1-877-840-1500

Discounts available for large quantities.
Contract pricing available. Call for details!

ALL OUR FORMS ARE OF THE HIGHEST QUALITY,  ARE PRINTED IN STRICT COMPLIANCE  WITH GOVERNMENT SPECIFICATIONS AND ARE APPROVED BY CENTERS FOR MEDICARE AND MEDICAID SERVICES AND THE INSURANCE INDUSTRY.
OUR FORMS HAVE BEEN APPROVED BY THE GOVERNMENT.
The American HCFA Forms division of DFL Enterprises, Inc. is an independent supplier of US Government
approved claim forms and NOT an affiliate of CMS (
www.cms.gov)

WE ACCEPT VISA, MASTERCARD and AMERICAN EXPRESS
 

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IF YOU HAVE ANY QUESTIONS OR TO ORDER BY PHONE
CONTACT US TOLL FREE AT:
 1-877-840-1500
FAX: 1-985-809-5788
Our Office Hours are:
  Monday - Thursday:  8am - 5pm CST
Friday:  8am - 12 noon CST

EMAIL US

AMERICAN HCFA FORMS is a Division of

124 Pine Oak Dr., Covington, LA  70433
PHONE:  985-875-0800
FAX: 1-985-809-5788

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