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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.
Currently out of stock
Item: 05110 | By: Paris Corporation
$169.06CT
$170.77
$170.77
Condition
New
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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