Health Insurance Claim Form
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  • SKU: 11275
  • Availability: In Stock (Usually ships in 1-2 days) (Stock Ship)
  • Mfr SKU: WCMS1500-CS12


The official standard form used by physicians and other providers when submitting bills/claims for reimbursement to Medicare or Medicaid for health services; it is also used by private insurers and managed care plans;

  • Mfr SKU: WCMS1500-CS12