UB04 Insurance Claim Form, 1-Part Continuous White, 9 1/2 x 11, 2500 Forms
$159.99
Tax excluded
Expedite Medicare, Medicaid or private insurance claims processing. Forms meet all Federal regulations. Formerly known as HCFA-1500 forms.
PRB05109
30 Items
Data sheet
- Footnote 1
- One-part continuous feed, white
- Special Features
- UB04 Hospital Insurance Claim Forms
- Paper Color(s)
- White
- Global Product Type
- Forms-Insurance
- Form Size
- 9 1/2 x 11
- Forms Per Page
- 1
- Form Quantity
- 2500
- Sheet Size
- 9 1/2 x 11
- Paper Stock
- 20 lb.
- Copy Types
- Continuous Feed
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Required by Centers for Medicaid and Medicare Services (CMS) and by most private healthcare organizations, these forms speed up claims processing and meet all federal guidelines.