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UB04 Hospital Claim Continuous Forms, 1-Part, Box Of 2,500

Item #799162
$77.99case

Description

    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.
    Specifications
    Item #799162
    Manufacturer #UB041
    printer compatibilityDot Matrix
    double sidedNo
    claim typeMedical
    sensor barsNo
    number of parts1
    Product LineHospital Claim Forms
    binding typePerforated
    quantity2500
    Eco Label StandardSFI Certified Fiber Sourcing
    Eco Label Standard deleteSFI Certified Fiber Sourcing
    manufacturerTAX FORMS PRINTING, INC.
    Product TypeMedical Claim Form
    $77.99case