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UB-04 Claim Form, CMS-1450 Hospital Claim Form, 8-1/2 x 11
UB-04 Claim Form, CMS-1450 Hospital Claim Form, 8-1/2 x 11

UB-04 Claim Form, CMS-1450 Hospital Claim Form, 8-1/2 x 11", Pack of 500

$ 12.13

Availability: 15 in stock
  • Country/Region of Manufacture: United States
  • MPN: N1AUB04
  • Refund will be given as: Money Back
  • Restocking Fee: No
  • Condition: New
  • All returns accepted: Returns Accepted
  • Brand: Tops Products
  • Model: UB-04 Claim Form
  • Return shipping will be paid by: Seller
  • Item must be returned within: 30 Days

    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.