501.372.6677 Little Rock
501.623.7742 Hot Springs
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Expedite Medicare, Medicaid or private insurance benefits. NUCC, CMS and AMA approved format. (02/12) version. Printed front and back in red OCR ink for scanning.
Laser Printer Compatible. Form Type Details: CMS-1500; Dated/Undated: Undated; Forms Per Page: 1; Form Size: 8.5 x 11.