Wilmer Compatible Filing Product Catalog

HEALTHCARE FORMS

Dental Claim Forms

1-Part Item No.

Description

Paper White White

Size

Color Black

Per carton Weight

Wada2019CS Wada2019csr

Continuous (2019) ADA Laser (2019) Red ADA

8 1 ⁄ 2 8 1 ⁄ 2

˝ x 11˝ ˝ x 11˝

2500 2500

30 Lbs 30 Lbs

OCR Red

2-Part Item No.

Description

Paper

Size

Color Black

Per Carton Weight

Wada20122

Continuous (2012) ADA

White/Canary

9 1 ⁄ 2

˝ x 11˝

1000

22 Lbs

Claim Forms

1-Part Item No.

Description

Paper White White White White White

Size

Color

Per Carton Weight

9 1 ⁄ 2 8 1 ⁄ 2 9 1 ⁄ 2 8 1 ⁄ 2 8 1 ⁄ 2

˝ x 11˝ ˝ x 11˝ ˝ x 14˝ ˝ x 11˝ ˝ x 11˝

OCR Red OCR Red OCR Red OCR Red OCR Red

2500 2500 2500 2500 2500

30 Lbs 30 Lbs 30 Lbs 30 Lbs 27 Lbs

Ccfub041* Nlcfub041*

Continuous Cms-1450

Laser Cms-1450

WCMS1500112

Continuous Cms 1500 (02/12)

WCMS1500CL12 Laser Cms 1500 (Al) (02/12) WCMS1500CS12 Laser Cms 1500 (02/12)

Note: Healthcare claim forms (AL) are designed for use in the state of Alabama with a lower right corner cut. *Revised to include NPI.

2-Part Item No.

Description

Paper

Size

Color

Per Carton Weight

Ccfub042*

Continuous CMS-1450

White/White

9 1 ⁄ 2

˝ x 11˝ ˝ x 11˝ ˝ x 11˝ ˝ x 11˝

OCR Red OCR Red OCR Red OCR Red

1000 1000 1000

22 Lbs 22 Lbs 22 Lbs 11 Lbs

White/Canary 9 1 ⁄ 2

Wcms1500212

Continuous CMS 1500 (02/12)

Wcms15002W12 Continuous CMS 1500 (02/12) Wcms1500U212 Ncr Uniset CMS 1500 (02/12)

White/White

9 1 ⁄ 2

White/Canary 8 1 ⁄ 2

500

Medical Laser Billing Statements

1-Part Item No.

Description

Paper White White White White White

Face Blue Blue

Size

Per Carton Weight

WLCS101-BK

Generic Laser Statements

8 1 ⁄ 2 8 1 ⁄ 2 8 1 ⁄ 2 8 1 ⁄ 2 8 1 ⁄ 2 8 1 ⁄ 2 8 1 ⁄ 2

˝ x 11˝ ˝ x 11˝ ˝ x 11˝ ˝ x 11˝ ˝ x 11˝ ˝ x 11˝ ˝ x 11˝

2000 2000 2000 2000 2000 2000 2000

27 Lbs 27 Lbs 27 Lbs 27 Lbs 27 Lbs 27 Lbs 27 Lbs

WLCS101MC-BK Generic Laser Statements, MC/VISA

WLCS104-BK WLCS105-BK WLCS106-BK WLCS107-BK WLCS108-BK

Generic Laser Statements, MC/VISA/DISC Generic Laser Statements, MC/VISA Generic Laser Statements, MC/VISA/DISC

Burgundy Burgundy

Blue Blue

Generic Laser Statements, MC/VISA/DISC/AMEX White

Generic Laser Statements

White

Burgundy

WLCS105-BK

WLCS107-BK

WLCS101-BK

9