UB04 Hospital Claim Continuous Forms, 1-Part, Box Of 2,500 Item # 799162
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Required for healthcare providers to bill a patient's insurance company for reimbursement of medical claims
- Forms must adhere to strict printing standards that govern the layout, paper and ink.
- Each form must have accurate content and conform to the Health Insurance Portability and Accountability Act (HIPAA). Developed in conjunction with all the governing agencies, including the National Uniform Claim Committee (NUCC), the National Uniform Billing Committee (NUBC), the CMS Centers for Medicare and Medicaid Services, the Health and Human Services Agency, and the American Hospital Association.
- Corresponding envelopes are sold separately.
|eco-label/standard||SFI Fiber Sourcing|
|machine compatibility||dot matrix printer|
|manufacturer||TFP Data Systems|
|number of parts||1|