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Claim Form Envelopes for CMS/HCFA 1500 & UB04 Claim Forms

CMS/HCFA 1500 Claim Form Envelopes
Available as:

  #10 (9-1/2" x 4-1/8") Right Window
  9"x 12.5" Right Window

UB-04 Claim Form Envelopes
Available as:

  #10 (9-1/2" x 4-1/8") Left Window
  9"x 12.5" Left Window
  9"x 5-13/16" Left Window

All envelopes have security liner for HIPAA compliance.
All envelopes are available as blanks or printed with your return address.

IMPRINT YOUR RETURN ADDRESS
Your return address can be imprinted
in the upper left of all envelopes.
Call for imprinting details. 1-877-840-1500

We have a variety of CMS-1500 and UB-04 claim form envelopes

ALL #10 ENVELOPES FOR CMS 1500 FORMS ARE SELF-SEAL.
ALL ENVELOPES HAVE SECURITY LINER.

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

Description

Picture of Envelope

Quantity/Case

Price/Case

Secure Order

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

ITEM # D38

CMS 1500 claim form envelopes

 

500

$32.00


Quantity:
 

NEW!
Printed
Envelopes for
CMS/HCFA 1500
#10 (9-1/2” x 4-1/8”)
Right Window
SELF-SEAL

ITEM # DI38

Imprinted CMS 1500 claim form envelopes

 

500

$55.00


Quantity:
 

Envelopes for
CMS/HCFA 1500

9”x12.5”
Right Window

ITEM # D36
 

Large CMS 1500 claim form envelopes
Click for Enlarged Image
of this Envelope

 

500

$95.00


Quantity:
 

Envelopes for
UB04

#10 (9-1/2” x 4-1/8”)
Left Window
NOT SELF-SEAL

ITEM # DUBENV10
 

UB-04 claim form envelopes

 

500

$32.00


Quantity:
 

NEW!
Printed

Envelopes for
UB04

#10 (9-1/2” x 4-1/8”)
Left Window
NOT SELF-SEAL

ITEM # DU10-IMPRINTED
 

Imprinted UB-04 claim form envelopes

500

$55.00

Quantity:

 

Envelopes for
UB04

9”x12.5”
Left Window

ITEM # DUB04CAT
 

Large UB-04 claim form envelopes
Click for Enlarged Image
of this Envelope

 

500

$95.00


Quantity:
 

Envelopes for
UB04

9"x 5-13/16"
Left Window

ITEM # DUBENVMED

Medium UB-04 claim form envelopes
Simply fold the UB04
in half and insert!
The envelope has an inside tint for HIPAA compliance and moistenable gum flap.

 

500

$72.00


Quantity:
 

NEW!
Printed
Envelopes for
UB04

9"x 5-13/16"
Left Window

ITEM # DUBENVMED-IMP

Imprinted medium UB-04 claim form envelopes
Simply fold the UB04
in half and insert!
The envelope has an inside tint for HIPAA compliance and moistenable gum flap.

500

$120.00

Quantity:

 

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

Helpful Information for users of CMS forms

CMSFORMS.COM
CMSFORMS.com is a division of DFL Enterprises, Inc.

ORDER SECURE ONLINE
OR CALL US TOLL FREE AT:
1-877-840-1500
OR BY FAX:
1-985-809-5788

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Monday - Thursday: 8am - 5pm CST
Friday: 8am - 12 noon CST

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DFL Enterprises, Inc.
124 Pine Oak Dr.
Covington, LA 70433