UB04 Insurance Claim Form, 2-Part, White/Canary, 9 1/2 x 11, 1000 Forms
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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.
| $107.79 USD Retail $170.77 |
Extended Warrenty
| 1 Year Extended Warrenty | $21.56 |
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Expedite Medicare, Medicaid or private insurance claims processing. Forms meet all Federal regulations. Formerly known as HCFA-1500 forms.
Product 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 |
| Global Product Type | Forms-Insurance |
| Package_Includes | Includes 1000 forms. |
| Paper Color(s) | Canary |
| Paper Color(s) | White |
| Paper Stock | 20 lb. |
| Sheet Size | 9 1/2 x 11 |
| Special Features | UB04 Hospital Insurance Claim Forms |
Material Safety Data Sheet
A Material Safety Data Sheet (MSDS) is a document that contains information on the potential hazards (health, fire, reactivity and environmental) and how to work safely with the chemical product.
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