Health Forms and Systems, Inc.
Nations Leading Supplier of
Medical Forms and Filing Supplies

Nationwide Delivery In
Approximately 2-3 business Days

 

Ten Regional Warehouses for Nationwide Delivery
(No Alaska or Hawaii)

Coldwater, Ohio
Tulare, California
Lithia Springs, Georgia
Miami, Florida
Philadelphia, Pennsylvania
Roselle, IL
Reno, NV
Charlotte, NC
Benton, AR
Minneapolis, MN
Dallas, Texas

 

Toll-Free 800-869-6590          Order Online          Toll-Free 800-869-6590          Order Online
 
NEW CMS 1500 SELF-SEAL ENVELOPES    Click Here
  • Self-Seal
  • Return Address Imprinted
  • Security Tint


CMS 1500 Laser (2500)
Per Case $25.75 ($10.30 per M)
Click Here

20+ Boxes - 50% Off Shipping on CMS Forms*
*excludes $48 UPS surcharge for inside delivery
Call Customer Service for Volume Shipping Discounts!

Click Here to View Our E-Sample Kit

NEW CMS 1500 Special Bundle Package

Includes:

  • Free Shipping! Free Shipping!
  • 1000 CMS 1500 Laser Forms
  • 500 Large CMS 1500 Envelopes
  • $99.00 per Bundle!

Click Here to Order

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Featured Products

Click the links below or scroll for information on these popular products.

  1. UB04 Claim Forms
  2. Patient Charts & Filing Systems
  3. Tamper-Resistant Prescription Pads For Medicaid
HCFA Claim Forms
Revised HCFA|CMS 1500 Form Shipping $9.80/Case

Click image to order online

New Revised HCFA|CMS
1500 Claim Forms

Patient Charts & Filing Systems
Click Here to see Styles

We offer a complete line of patient charts, X-ray jackets, chart index dividers, color coding labels and more. See our online catalog.

New UB04 Claim Forms

UB04 Form
Click image to order online

The National Uniform Claim Committee (NUCC) announces the approval of the UB04 Billing Claim Form as the replacement for the UB-92.

Why is it changing? The UB04 contains a number of improvements and enhancements that include better alignment with the electronic HIPAA ASC X12N 837-Institutional Transaction Standard. The New UB04 paper billing form will be able to accommodate the reporting of the National Provider Identifier (NPI) Number. The NPI will be a single provider identifier, replacing the different provider identifiers healthcare systems currently use for each health plan with which you do business. The NPI Identifier, which implements a requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), must be used by all HIPAA covered entities, which are health plans, healthcare clearinghouses, and healthcare providers.UB04 timeline:

March 1, 2007 - Health plans, clearinghouses, and other information that support vendors should be ready to handle and accept the new UB04 form and data set.

March 1, 2007 - May 22, 2007 - Providers can use either the UB04 or UB92 forms/data set specifications.

May 23, 2007 - The UB92 is discontinued; only the UB04 forms and data set specifications should be used.

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TAMPER-RESISTANT PRESCRIPTION PADS FOR MEDICAID
  • Call Customer Service For Fast Order Processing (3 Days) (800) 869-6590
  • Free Shipping!

1 Part Pads - 100 per Pad
  • 10 Pads - $49.00 + 2 Pads Free
  • 20 Pads - $79.00 + 2 Pads Free
  • 40 Pads - $149.00 + 4 Pads Free

2 Part NCR w/Copy - 50 sets per Pad
  • 20 Pads - $89.00 + 4 Pads Free
  • 40 Pads - $149.00 + 4 Pads Free
  • 80 Pads - $299.00 + 8 Pads Free

TAMPER-RESISTANT PRESCRIPTION PADS FOR MEDICAID
IMPORTANT INFORMATION
PAD FEATURES

Health Forms Tamper-Resistant Prescription Pads and Laser Rx Stock

Introducing Health Forms tamper-Resitant Prescription Pads with seven security features, including the highly secure thermochromic ink. Health Forms goes far beyond the requirements of the Center of Medicare and Medicaid mandated security features required for Medicaid RX’s for October 2008.

In addition to the federal regulations, Health Forms exceeds the requirements of the following states as well:
CA, FL, IN, KY, ME, WV, and WY.

  • Free Shipping!
  • Competitive Delivery —
    5-7 business days after order approval plus shipping time
  • Competitive Pricing
  • Competitive Order Quantities —
    MIN 12 PAD ORDERS ACCEPTED!
  • 1 part and 2 part prescription pads
  • Laser RX Stock also available
  • Convenient pocket-sized pads
    4-1/4”w x 5-1/2”h (Vertical),
    5-1/2”w x 4-1/4”h (Horizontal)
  • Competitive Product —
    Includes multiple security features:
    • *Rx red thermochromic ink easily identi¬fies original; fades with heat
    • *Preprinted Prescriber information
    • *Blue or green background
    • *Watermark on back
    • *Void Pantograph on front
    • *Chemical protection paper
    • *Microprint in border
We accept MasterCard, VISA, American Express, Discover, eCHECK and PayPal

Toll-free phone: (800) 869-6590
Toll-Free Fax: (800) 307-8606

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