Description: UB-04 Claim Form, CMS-1450 Hospital Claim Form, 8-1/2 x 11" Pack of 500. Approved OMB No. 0938-0997. UB-04 laser-cut forms are designed for medical offices to file a claim with the patient's insurance company. Forms are printed to GPO standards in OCR ink on 20 lb. bond. The Health Care Finance Administration format ensures accuracy in reporting all necessary information. Forms meet the requirements of the Centers for Medicare and Medicaid Services (CMS). Laser and inkjet compatible. Replaces the UB-92 form.
Price: 22.99 USD
Location: Niles, Illinois
End Time: 2024-12-06T16:24:12.000Z
Shipping Cost: 0 USD
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Item Specifics
Restocking Fee: No
Return shipping will be paid by: Seller
All returns accepted: Returns Accepted
Item must be returned within: 30 Days
Refund will be given as: Money Back
Brand: Tops Products
Model: UB-04 Claim Form
MPN: N1AUB04
Country/Region of Manufacture: United States
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