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

$169.99
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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.

Expedite Medicare, Medicaid or private insurance claims processing. Forms meet all Federal regulations. Formerly known as HCFA-1500 forms.
PRB05110
69 Items

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

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