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E-Z BIS Paper Products

E-Z BIS offers a variety of CMS-1500 claim forms and other medical office forms and supplies to complement your E-Z BIS chiropractic software or any practice management software. To order, call E-Z BIS at (800) 445-7816 or send email to papersales@ezbis.com.

CMS-1500 Insurance Forms and Envelopes

Laser CMS-1500  
CMS-1500 single-sheet claim forms for laser and ink-jet printers. 02/12 version supports ICD-10 diagnosis codes
Item No.
Description
1 Box   2 - 4   5 or more
CMS12L 02/12 version, single-sheet, box of 2500 74.95   72.95   69.95
CMS12C1 02/12 version, 1-part continuous, box of 2500 89.95   86.95   83.95
CMS12C2 02/12 version, 2-part continuous, box of 1000 119.95   116.95   113.95
HCFA90L 08/05 version, single-sheet, box of 2500 69.95   66.95   63.95
HCFA901 08/05 version, 1-part continuous, box of 2500 84.95   82.95   79.95
HCFA90N 08/05 version, 2-part continuous, box of 1000 119.95   116.95   113.95

Small Insurance Envelopes  
Small, 4½" x 9½" windowed envelopes for folded claims. Includes security tint for patient privacy required under HIPAA.
Item No.
Description
1000 Envelopes   2500 Envelopes
EISWS Small self-seal envelope with right-positioned window for claims with bar code. 83.96   189.75
EISW Small gummed envelope with right-positioned window for claims with bar code. 67.96   159.75

Large Insurance Envelopes  
Large, 12 ½" x 9" windowed envelopes for unfolded claims. Includes security tint for patient privacy required under HIPAA.
Item No.
Description
500 Envelopes   1000 Envelopes   2500 Envelopes
EILWS Large self-seal envelope with right-positioned window for claims with bar code. 99.95   195.96   479.75

UB-04 Form

UB-92 Form  
UB-04 hospital claim form. (also known as CMS-1450) Single-sheet for laser and ink-jet printers.
Item No.
Description
1 Box   2 - 4   5 or more
UB04L UB-04 form, box of 2500. 79.95   77.95   75.95

Statement Forms and Envelopes

m  
8½" x 11" statement form for monthly patient statements, attorney statements and individual itemized statements. Available in single-sheet for laser and inkjet printers and continuous feed for dot-matrix printers.
Item No.
Description
1 Box   2 - 4   5 or more
PSL Single-sheet, box of 1000. 39.95   35.95   31.95
PSC One part continuous , box of 2500. 99.95   n/a   94.95

Statement Envelope  
3 7/8" x 8 7/8" double-windowed envelopes for statement forms. Includes “Return Service Requested” for address correction.
Item No.
Description
1000 Envelopes   2500 Envelopes
EDW9 Gummed, double-window envelope for statement forms. 61.96   144.75
EDW9S Self-seal, double-window envelope for statement forms. 87.96   209.75

Perforated Receipt Paper

Letter-sized Receipt  
White, 8 ½" x 11" paper, pre-perforated 3 2/3" from the bottom for detachable appointment reminder with calendars. Requires E·Z BIS Office version 7.0 or higher.
Item No.
Description
1 Box   2 - 4   5 or more
PRP Blank, pre-perforated paper, box of 2500. 59.95   56.95   52.95

To order, call E-Z BIS at (800) 445-7816 or send email to papersales@ezbis.com.

 

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