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UB04 Insurance Claim Form, 2-Part, White/Canary, 9 1/2 x 11, 1000 Forms

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.
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Item: 05110 | By: Paris Corporation
$169.06CT
$170.77
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Supply Part #
PRB05110
Condition
New
  • Expedite Medicare, Medicaid or private insurance claims processing.
  • Forms meet all Federal regulations.
  • Formerly known as HCFA-1500 forms.
  • Product description

    Specifications

    Copy Types
    Continuous Feed
    Footnote 1
    Two-part continuous feed white/white. Carbonless
    Form Quantity
    1000
    Form Size
    9 1/2 x 11
    Forms Per Page
    1
    Package_Includes
    Includes 1000 forms.
    Paper Color(s)
    White
    Paper Color(s)
    Canary
    Paper Stock
    20 lb.
    Sheet Size
    9 1/2 x 11
    Special Features
    UB04 Hospital Insurance Claim Forms
    Product Type
    Forms-Insurance

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