UB04 & CMS-1500 / HCFA-1500  CLAIM FORM ENVELOPES
ALL ENVELOPES ARE SELF-SEAL AND HAVE SECURITY LINER.

#10 Envelope
CMS/HCFA 1500
Right Window

9"x12.5" Envelope
CMS/HCFA 1500
Right Window

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TO ENLARGE

***#10 Envelope
UB04
Left Window

9"x12.5" Envelope
UB-04
Left Window

CLICK IMAGE
TO ENLARGE

Description

Quantity/Case

Price/Case

Secure Order

#10 (9-1/2" x 4-1/8") Right Window
Envelopes for CMS/HCFA 1500

500

$29.20


Quantity:
 

9"x12.5" Right Window
Envelopes for CMS/HCFA 1500

500

$89.60


Quantity:
 

***#10 (9-1/2" x 4-1/8") Left Window
Envelopes for UB04

500

$29.20


Quantity:
 

9"x12.5" Left Window
Envelopes for UB04

500

$89.60


Quantity:
 

***#10 Self-Seal Envelope for UB04 - Inside tint for HIPAA compliance.
   
We can imprint your company return address.  Call for information. 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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