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
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CMS-1500 single-sheet claim forms for laser and ink-jet printers. Supports the National Provider ID. (formerly HCFA-1500 claim form) |
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Item No. |
Description |
1 Box |
|
2 - 4 |
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5 or more |
| HCFA90L |
Single-sheet for laser or inkjet, box of 2500 |
59.95 |
|
56.95 |
|
53.95 |
| HCFA901 |
One-part continuous, box of 2500 |
69.95 |
|
64.95 |
|
59.95 |
| HCFA90N |
Two-part continuous, box of 1000 |
69.95 |
|
64.95 |
|
59.95 |
|
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Small, 4½" x 9½" windowed envelopes for folded claims. Includes security tint for patient privacy required under HIPAA. |
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Item No. |
Description |
1000 Envelopes |
|
2500 Envelopes |
| EISWS |
Small self-seal envelope with right-positioned window for claims with bar code. |
69.96 |
|
157.95 |
| EISW |
Small gummed envelope with right-positioned window for claims with bar code. |
59.96 |
|
149.95 |
|
 |
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Large, 12 ½" x 9" windowed envelopes for unfolded claims. Includes security tint for patient privacy required under HIPAA. |
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Item No. |
Description |
500 Envelopes |
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1000 Envelopes |
|
2500 Envelopes |
| EILWS |
Large self-seal envelope with right-positioned window for claims with bar code. |
89.95 |
|
169.96 |
|
395.95 |
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UB-04 Form
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UB-04 hospital claim form. (also known as CMS-1450) Single-sheet for laser and ink-jet printers. |
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Item No. |
Description |
1 Box |
|
2 - 4 |
|
5 or more |
| UB92L |
UB-04 form, box of 2500. |
79.95 |
|
75.95 |
|
71.95 |
|
Statement Forms and Envelopes
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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. |
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Item No. |
Description |
1 Box |
|
2 - 4 |
|
5 or more |
| PSL |
Single-sheet, box of 1000. |
41.95 |
|
38.95 |
|
36.95 |
| PSC |
One part continuous , box of 2500. |
89.95 |
|
n/a |
|
84.95 |
|
 |
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3 7/8" x 8 7/8" double-windowed envelopes for statement forms. Includes “Return Service Requested” for address correction. |
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Item No. |
Description |
1000 Envelopes |
|
2500 Envelopes |
| EDW9 |
Gummed, double-window envelope for statement forms. |
49.96 |
|
112.95 |
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Perforated Receipt Paper
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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. |
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Item No. |
Description |
1 Box |
|
2 - 4 |
|
5 or more |
| PRP |
Blank, pre-perforated paper, box of 2500. |
59.95 |
|
56.95 |
|
52.95 |
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To order, call E-Z BIS at (800) 445-7816 or send email to papersales@ezbis.com.
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