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Medical & Dental Insurance Forms

Stake Your Claim Promptly & Efficiently!

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We offer HCFA 1500 forms in continuous 1, 2 and 3 part formats with and without bar codes. We also offer HCFA forms in carbonless 2 part unit sets and laser cut sheets. All of the HCFA 1500 forms are printed in OCR blind red ink and are compatible with all major medical software packages. We also offer HCFA 1500 compatible window envelopes to eliminate addressing time. Our forms are standardized for use by hospitals, clinics, nursing homes and physicians throughout the country! Fortunately, veterinarians are not required or allowed to use these forms :-)

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Our HCFA 1500 forms are compatible with Excaliber, MED IV, MOGO, OR-D, Pacific, PAL/MED, Softek and most other medical software packages. If you are unsure of of which form(s) to order, you may request FREE SAMPLES to test your software and printer's print positions!

Our HCFA 1500 forms are printed in OCR blind red ink in compliance with government standards. We guarantee that our forms will meet all HCFA requirements to process Medicare Part B claims. Most private insurance carriers will also accept claims submitted on HCFA 1500 forms.

Z-O-O-M ! We Ship Quickly!

Stock forms and envelopes without imprinting ship in 24 hours. We ship from 5 regional warehouses to keep your freight costs at an absolute minimum. Imprinted forms and envelopes ship in 72 hours. Imprinted forms include the physician's name, address and I.D. number.

New Lower HCFA Forms Prices Free Shipping On 20 Case Orders!

We just qualified for a new 1,000,000 forms pricing contract as of November 1999 and we are passing the savings on to you. Our prices on full case lots and purchase commitments of 25,000+ forms are an average of 5%-15% lower than they used to be! We also qualified for free shipping on orders for 20 cases or more. Now you can save up to $150 in freight charges on 20 case orders! Please e-mail, fax or call us for a price quotation today to take advantage of our new lower prices and free shipping on larger orders.

We supply regular and self sealing envelopes that are compatible with all HCFA 1500 forms. You may choose between imprinted envelopes and blank stock. We also offer a UB92 compatible envelope. Regular envelopes have room to display 4 lines of imprinting in a variety of typestyles and 12 ink colors. The regular envelopes are blue tinted on the inside to insure privacy. Optional logos may be printed on the regular envelopes. Self sealing envelopes can be imprinted in Spartan Black only with no logo.

We also offer standard 2 part 1984 C2 Revision forms with bar code in black ink and without bar code in blue ink. UB 92 HCFA 1450 continuous forms are available in 1 to 5 part formats in OCR blind red ink. A laser cut sheet version is also offered.

Our dental insurance claim forms (Attending Dentist Statements) are approved by the American Dental Association. We offer ADA/ADS approved versions for 1985, 1986, 1987, 1990, 1994 and 2000 in 1 or 2 parts in black ink. All dental claim forms may be imprinted or ordered as blank stock. Pricing for the dental claim forms is the same as for the HCFA forms as listed above.

Use our new HIPAA forms to comply with Federal HIPAA privacy regulations. The forms integrate easily with your existing medical records system, simplify administrative processing and ensure that patients' privacy rights are not violated.

• HIP101 - HIPAA Employee Training Record
• HIP102 - HIPAA Practice Training Record
• HIP103 - PHI Access Log
• HIP104 - PHI Disclosure Log
• HIP105 - Patient Request For Amendment of Health Information
• HIP106 - Patient Request For Accounting of Disclosures
• HIP107 - Patient Request To Inspect/Review PHI
• HIP108 - Patient Request For Confidential Communications
• HIP109 - Patient Request For Restrictions On Use & Disclosure of PHI
• HIP110 - PHI Tracking Log
• HIP120 - Notice of Privacy Practices (Includes Acknowledgement)

Our new forms make it easier for you to comply with HIPAA. Please call us for a competitive quotation on your HIPAA forms requirements.

Our HCFA, HIPAA and Dental Insurance claim forms are priced at least 10% below suggested resale prices. If your software can print the required name, address and ID number information, you can save even more! Our blank stock forms are priced another 10% to 25% lower than our imprinted forms. Better yet, we offer Combo Pricing! You may mix and match claim forms and envelopes on your order to reach better quantity price break levels. We also offer special pricing on 6 month purchase commitments of 25,000+ forms and 1 year purchase commitments of 50,000+ forms. Minimum shipments on purchase commitments are in case lot quantities (usually 1,000 or 2,500 forms). Call or e-mail us today to receive our insurance form flyer or an immediate quotation.

We use stocking warehouses in PA, GA, OH, and CA for our medical claims forms to keep shipping costs at an absolute minimum. Ordering and shipping information for hospital and dental insurance forms are the same as for our software compatible forms. You can link to our Ordering Information Page to get answers to any questions that you might have about our unconditional guarantee, ordering procedures, shipping information and payment methods, etc.

We accept Company Checks, Personal Checks, American Express, Discover, MasterCard and VISA as acceptable forms of payment on all orders. Sorry, but we can't accept COD orders. Payment by credit card assures you of the fastest possible delivery time.

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E-mail: bizforms@adelphia.net Voice:   Please Call From 9AM-6PM MST      800-778-8577 or 719-576-2789 Fax:       719-576-2790

Uncle Sam's Postal Octopus (USPO):     American International Consultants     445C East Cheyenne Mountain Blvd. #334     Colorado Springs, CO 80906

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