ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
$29.39
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Highlights
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- Designed for hospitals to file a medical claim with the patient's insurance carrier
- One-part health insurance forms
- Printed with OCR dropout red ink on white paper
MADE IN AMERICA
ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
Item #: 24614845Model #: UB04LC5
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$29.39
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About this product
Complete billing tasks with these TFP UB-04 one-part hospital claim forms
Ensure proper processing of medical procedures and patient care with these hospital claim forms. The 20-pound bond paper offers added durability and is easy to load in office printers, while the one-part format creates a crisp, high-quality master copy. Each of these TFP UB-04 hospital claim forms features preprinted sections for services, codes, and rates, along with each patient's personal information for accurate reporting.
- Designed for hospitals to file a medical claim with the patient's insurance carrier
- One-part health insurance forms
- Printed with OCR dropout red ink on white paper
- Developed in conjunction with all the governing agencies
- Comes in laser-cut sheet format
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| Attributes | ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5) | ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250) | ComplyRight 2024 ADA Dental Claim Forms, 500 Forms/Pack (20241500) | ComplyRight 2024 ADA Dental Claim Forms, 2,500 Forms/Pack (20241) | ComplyRight 2024 ADA Dental Claim Forms, 100 Forms/Pack (20241100) |
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Your product ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5) Price is $29.39 |  Price is $34.09 |  Price is $43.59 |  Price is $133.69 |  Price is $16.79 | |
| Reviews | |||||
| Delivery Information | Delivery by Fri, Dec 19 | Next-Day Delivery by tomorrow | Free delivery by Mon, Dec 15 | Free delivery by Mon, Dec 15 | Delivery by Mon, Dec 15 |
| Available in my store | No | No | No | No | No |
| Medical Form Pack Size | 500 | 250 | 500 | 2500 | 100 |
| Medical Form Type | Health Insurance Claims | Health Insurance Claims | Dental Claims | Dental Claims | Dental Claims |
| Length in Inches | 11 | 11 | 11 | 11 | 11 |
| Width in Inches | 8.5 | 8.5 | 8.5 | 8.5 | 8.5 |
| Print Type | Laser | Laser | Laser | Laser | Laser |
| Acid Free | Acid Free | Data not available | Acid Free | Acid Free | Acid Free |
| Add To Cart | Add To Cart | Add To Cart | Add To Cart |
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