UB04 Insurance Claim Form, 1-Part Continuous White, 9 1/2 x 11, 2500 Forms

$159.99
Tax excluded
Quantity
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.

Expedite Medicare, Medicaid or private insurance claims processing. Forms meet all Federal regulations. Formerly known as HCFA-1500 forms.
PRB05109
30 Items

Data sheet

Special Features
UB04 Hospital Insurance Claim Forms
Footnote 1
One-part continuous feed, white
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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