H.C.F.A. Forms

HCFA Form

The HCFA-1500 Form is a Health Insurance Claim Form. The form is required to reimburse health care providers for services rendered to injured employees covered under OWCP-administrative programs.

Inserters can fold and insert an H.C.F.A. form but it requires a custom fold. The mailing address is located at the very top of the form so a traditional C-Fold will not work.

The settings below should be used:
- The settings may vary +/- 5mm to fit correctly in a window envelope.

Models   Fold Type    Fold Setting Paper Direction
M3000 / SI-62
M3000 / DS-62
M4000 / SI-68
M5000 / DS-70
M6000 / SI-76
M7000 / DS-80 
M8000 / SI-82
M8600 / DS-86
Z-Fold 1st Fold: 95mm
2nd Fold: 165mm
Face up address leading
M6000 / SI-76
M7000 / DS-80
M8000 / SI-82
M8600 / DS-86
(Machines fitted with turnover plate)
Double Parallel Fold 1st Fold: 40mm
2nd Fold: 130mm
Face up address leading
M9000 / SI-92 Double Parallel Fold 1st Fold: 132mm
2nd Fold: 90mm
FE-7: Face down address trailing

AS1A: Face up address leading

Date created:
05/22/2013 04:45:20
Last updated:
03/16/2018 14:10:00
Product(range):
DS-62, DS-70, DS-80, DS-86, SI-62, SI-68, SI-76, SI-82, SI-92
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