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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.
| $107.79USD | Retail $170.77 |
Manufacturer:
PARIS CORPORATION
Item:
05110
UPC Code:
090146051103
Condition
New
Extended Warrenty
| 1 Year Extended Warrenty | $21.56 |
$107.79USD
$170.77
$170.77
Availability
In Stock
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Product description
Expedite Medicare, Medicaid or private insurance claims processing. Forms meet all Federal regulations. Formerly known as HCFA-1500 forms.
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