UB04 Insurance Claim Form, 2-Part, White/Canary, 9 1/2 x 11, 1000 Forms
$184.44
Tax excluded
Expedite Medicare, Medicaid or private insurance claims processing. Forms meet all Federal regulations. Formerly known as HCFA-1500 forms.
PRB05110
Data sheet
- Special Features
- UB04 Hospital Insurance Claim Forms
- Footnote 1
- Two-part continuous feed, white/white. Carbonless
- Paper Color(s)
- White
- Paper Color(s)
- Canary
- Global Product Type
- Forms-Insurance
- Form Size
- 9 1/2 x 11
- Forms Per Page
- 1
- Form Quantity
- 1000
- Sheet Size
- 9 1/2 x 11
- Paper Stock
- 20 lb.
- Copy Types
- Continuous Feed
- Unit Of Measure
- CT
No customer reviews for the moment.
16 other products in the same category:
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.