Skip to main content Skip to footer
Helping your business win

Unlock $20 Off & Exclusive Deals! Redeem Now

Chat| 1-800-982-3400
Fanatical customer service since 1956
Coupons & Rewards Hot Deals Buy Again
Save 5% with Rewards+
Track an order
Shared cart
Reward not redeemed
You dont have enough points to redeem this reward.
Favorite list
Alternative Items
TFP UB-04 CMS-1450 1-Part Health Insurance Claims, 2500/Carton (UB04LC)
TFP UB-04 CMS-1450 1-Part Health Insurance Claims, 2500/Carton (UB04LC)
$114.29
Per carton
Add to cart
Earn 114 points
Description
Specifications
Reviews
  1. Home
  3. Paper
  5. Forms & Recordkeeping
  7. Forms & Recordkeeping
  9. HR Forms
  11. HR & Medical Forms

TFP UB-04 CMS-1450 1-Part Health Insurance Claims, 2500/Carton (UB04LC)

Order TFP UB-04 CMS-1450 1-Part Health Insurance Claims, 2500/Carton (UB04LC) today at Quill.com and get fast shipping. Stack coupons to get free gifts & extra discounts!
Item #: 901-519727
Model #: UB04LC
Brand: TFP
(3 reviews)
Item #: 901-519727
TFP UB-04 CMS-1450 1-Part Health Insurance Claims, 2500/Carton (UB04LC)
TFP UB-04 CMS-1450 1-Part Health Insurance Claims, 2500/Carton (UB04LC)
$114.29
Per carton
1 CARTON = 2500 EACH
Upgrade to get 5% off, earn points 10% faster and more. Annual fee of $49.99.
TFP UB-04 CMS-1450 1-Part Health Insurance Claims, 2500/Carton (UB04LC)
Add to cart
Earn 114 points
Free delivery
Ship to: 60069
Submit
Free delivery
Mon, May 5 - Tue, May 6
Free returns
Add to list
Request bulk pricing

Frequently bought together

TFP UB-04 CMS-1450 1-Part Health Insurance Claims, 2500/Carton (UB04LC) TFP UB-04 CMS-1450 1-Part Health Insurance Claims, 2500/Carton (UB04LC)
This item TFP UB-04 CMS-1450 1-Part Health Insurance Claims, 2500/Carton (UB04LC)
Item #: 901-519727
(3)
$114.29
Per carton

$114.29

Add to cart
+
Quill® Economy Columnar Pads for Prong Fasteners; 4 Columns, 50 Sheets/Pad, 10 Pads/Pack (95141) Quill® Economy Columnar Pads for Prong Fasteners; 4 Columns, 50 Sheets/Pad, 10 Pads/Pack (95141)
Quill® Economy Columnar Pads for Prong Fasteners; 4 Columns
Item #: 901-745804
(15)
$81.69
1-3 pack
Save 19%
$65.99
4+ pack

$81.69

Add to cart
+
Columnar Book, 6 Columns, 7.25" x 9.5", Blue Granite, 40 Sheets/Book (217752) Columnar Book, 6 Columns, 7.25" x 9.5", Blue Granite, 40 Sheets/Book (217752)
Columnar Book, 6 Columns, 7.25" x 9.5", Blue Granite, 40 Sheets/Book (217752)
Item #: 901-217752
(66)
$18.39
Per each

$18.39

Add to cart
Total $214.37
Add all to cart

Customers also viewed

Quill Brand® 2 Columns Columnar Book, 7.25W x 9.5H, Blue Marble (18846/26515)
Quill Brand® 2 Columns Columnar Book, 7.25"W x 9.5"H, Blue Marble (18846/26515)
Item #: 901-217729
(253)
$20.39
Per each
Add
Earn 20 points
Wilson Jones Columnar Sheets, Ledger Paper, Ruled, 30 Lines, 20 Columns, Green Paper, 9 1/4 x 11 7/
Wilson Jones Columnar Sheets, Ledger Paper, Ruled, 30 Lines, 20 Columns, Green Paper, 9 1/4" x 11 7/8", 100/Pk
Item #: 901-WG1020A
(15)
$119.39
Per pack
Add
Earn 119 points
Wilson Jones Columnar Sheets, Ledger Paper, Ruled, 30 Lines, 6 Columns, Green Paper, 9 1/4 x 11 7/8
Wilson Jones Columnar Sheets, Ledger Paper, Ruled, 30 Lines, 6 Columns, Green Paper, 9 1/4" x 11 7/8", 100/Pk
Item #: 901-508497
(12)
$119.39
1-2 pack
Save 24%
$89.99
3+ pack
Add
Earn 119 points
Quill Brand® Columnar Book, 3-Columns, 80 Pages, Blue Marble (18847/26516)
Quill Brand® Columnar Book, 3-Columns, 80 Pages, Blue Marble (18847/26516)
Item #: 901-217737
(286)
$13.29
Per each
Add
Earn 13 points
Quill Brand® Columnar Book, 12-Columns, 80 Pages, Blue Marble (18852/26519)Quill Brand® Columnar Book, 12-Columns, 80 Pages, Blue Marble (18852/26519)
Quill Brand® Columnar Book, 12-Columns, 80 Pages, Blue Marble (18852/26519)
Item #: 901-217976
(164)
$16.29
1-2 each
Save 7%
$14.99
3+ each
Add
Earn 16 points
Boorum & Pease 1602 1/2 Series Columnar Book, 12 Columns, 10.13 x 12.25, Black, 75 Sheets/Book (16
Boorum & Pease 1602 1/2 Series Columnar Book, 12 Columns, 10.13" x 12.25", Black, 75 Sheets/Book (1602 1/2-150-12)
Item #: 901-2667635
(1)
$114.29
Per each
Add
Earn 114 points
Wilson Jones Ledger Paper, 24 Columns, 11 x 14, Green, 100 Sheets (WLJG3024)
Wilson Jones Ledger Paper, 24 Columns, 11" x 14", Green, 100 Sheets (WLJG3024)
Item #: 901-2660911
(2)
$121.49
1-2 each
Save 16%
$100.99
3+ each
Add
Earn 121 points
Staples 13 Columns Columnar Book, 16.31W x 11H, Green (217893)
Staples 13 Columns Columnar Book, 16.31"W x 11"H, Green (217893)
Item #: 901-217893
(141)
$22.49
Per each
Add
Earn 22 points
Columnar Book, 6 Columns, 7.25 x 9.5, Blue Granite, 40 Sheets/Book (217752)
Columnar Book, 6 Columns, 7.25" x 9.5", Blue Granite, 40 Sheets/Book (217752)
Item #: 901-217752
(66)
$18.39
Per each
Add
Earn 18 points
Staples Columnar Book, 50 Pages, Green (217885)
Staples Columnar Book, 50 Pages, Green (217885)
Item #: 901-217885
(150)
$22.19
Per each
Add
Earn 22 points
Staples® Columnar Books, 100 Pages, Green, 2/Pack (217851ABF)
Staples® Columnar Books, 100 Pages, Green, 2/Pack (217851ABF)
Item #: 901-217851
(179)
$21.39
1-2 pack
Save 17%
$17.59
3+ pack
Add
Earn 21 points
Staples Columnar Books, 100 Pages, Green, 2/Pack (217844ABF)
Staples Columnar Books, 100 Pages, Green, 2/Pack (217844ABF)
Item #: 901-217844
(281)
$20.39
Per pack
Add
Earn 20 points
Staples® Columnar Books, 100 Pages, Green, 2/Pack (217869)
Staples® Columnar Books, 100 Pages, Green, 2/Pack (217869)
Item #: 901-217869
(265)
$24.49
Per pack
Add
Earn 24 points
Quill Brand® 4-Column Columnar Book, 80 Pages, Blue Marble (18848/26517)
Quill Brand® 4-Column Columnar Book, 80 Pages, Blue Marble (18848/26517)
Item #: 901-217745
(160)
$24.49
Per each
Add
Earn 24 points
Staples® Record Book, 300 Pages, Black (18658/26510)Staples® Record Book, 300 Pages, Black (18658/26510)
Staples® Record Book, 300 Pages, Black (18658/26510)
Item #: 901-217695
(62)
$50.99
Per each
Add
Earn 50 points
Staples Ledger Binder, 200 Pages, Blue Marble (26520)
Staples Ledger Binder, 200 Pages, Blue Marble (26520)
Item #: 901-296509
(60)
$42.89
Per each
Add
Earn 42 points
Description
Specifications
Reviews
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
  • Contains 2500 forms per carton
  • Printed with OCR dropout red ink on white paper
  • Developed in conjunction with all the governing agencies
  • Comes in laser-cut sheet format
Brand
TFP
Medical Form Pack Size
2500
Medical Form Type
Health Insurance Claims
Number of Parts
1
Pack Qty
250
Print Type
Laser
Series or Collection
UB-04 CMS-1450
True Color
White/Red
Quill logo

Helping your business win

Get supplies, get rewards

Earn one point for every dollar spent, with so many ways to use them.

Your order has arrived

Fast, free shipping on orders $25 or more. Returns are easy, too.

Savings on savings on savings

Stack promotions, coupons, & rewards, stretching your dollars.

We love phone calls

Our award-winning customer service is here to help anytime.
Just call 1-800-982-34001-800-982-3400

Your feedback helps us serve you better

Share Your Thoughts With Us on

Quill help center

Call us 1-800-982-3400

New to Quill? Would you like to learn more about how we can help your business?

Start a chat.
Email us.
Looking for coupons?
You will be redirected to travel.quill.com in a new tab. Hit Okay to continue.
Okay
Go to Cart
Subtotal: ( items / rewards):
Rewards balance:
Rewards & coupons center
Loading your cart
Quick view
Shared Cart Details
Please review this product
Upgrade to Rewards+
$49.99/year
Member benefits
Free shipping-no minimum
As a member, you never have to worry about hitting an order minimum
View policy
5% off everyday low prices
Sales not included
Plus, save an additional 5% off our best 10-ream paper price
Earn 10% more points for every $1 spent
Exclusive Rewards+ offers
Site-wide price match
View policy
Receive 30 extra days to use your points
Disclaimer
Offers and discounts exclude HP,Samsung and Epson. We offer a worry-free enrollment guarantee - if you are not satisfied with your Rewards+ membership, you can cancel at any time for a prorated refund. By enrolling into the Reward+ program, you are agreeing to the Terms and Conditions.
See full membership details