UB-04 Hospital Claim Form - 10,000 Forms
Version 02/12

UB-04 Hospital Claim Form - 10,000 Forms

Your Price: $220.00
Retail Price:$599.99
You Save:$379.99(63%)
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Part Number:UB04CF


Size: 8 1/2 x 11"


500 Forms per unit

Speed third-party billing and manage your cash flow with this AMA and CMS approved claim form for your laser printer.
Includes all updates to the 02/12 version approved by the NUCC (National Uniform Claim Committee)

  • Convenient and easy to use! 1-part form on 20# white bond stock, printed in OCR red ink.
  • Accommodates NPI numbers as mandated by HIPAA.
  • Accepted by most health insurance companies.
  • Single sheet format works with most laser printers.
  • Quantity: Comes in packs of 500

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