ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
Item #:
901-24614845
Model #:
UB04LC5
Brand:
ComplyRight
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$40.39
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ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
Description
Complete billing tasks with these TFP UB-04 one-part hospital claim forms
Ensure proper processing of medical procedures and patient care with these hospital claim forms. The 20-pound bond paper offers added durability and is easy to load in office printers, while the one-part format creates a crisp, high-quality master copy. Each of these TFP UB-04 hospital claim forms features preprinted sections for services, codes, and rates, along with each patient's personal information for accurate reporting.
- Designed for hospitals to file a medical claim with the patient's insurance carrier
- One-part health insurance forms
- Printed with OCR dropout red ink on white paper
- Developed in conjunction with all the governing agencies
- Comes in laser-cut sheet format
Specifications
Acid Free
Acid free
Brand
ComplyRight
Length in Inches
11
Made in America
Yes
Medical Form Pack Size
500
Medical Form Type
Health Insurance Claims
Pack Qty
500
Print Type
Laser
Width in Inches
8.5
