ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
$30.19
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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
ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
Item #: 24614845Model #: UB04LC5
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$30.19
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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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Page 1 of 4
Price is $48.99
Unit of measure 500/Carton Price per unit $0.10/Bag
Free delivery by Tue, Nov 17
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Price is $17.49
Unit of measure 50/Pack
Delivery by Fri, Nov 20
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Price is $6.89
Unit of measure 12/Box
Delivery by Tue, Nov 17
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Price is $13.79
Unit of measure 160/Pack Price per unit $0.09/Flag
Delivery by Tue, Nov 17
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Price is $28.49
Unit of measure 250/Box
Delivery by Mon, Nov 23
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Compare similar items
| Attributes | ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5) | ComplyRight 2024 ADA Dental Claim Forms, 2,500 Forms/Pack (20241) | ComplyRight Notice of Privacy Practice, 100/Pack (A1349) | ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250) | ComplyRight Confidential Employee Medical Records Folder, Pack of 25 (A2211) |
|---|---|---|---|---|---|
Your product ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5) Price is $30.19 |  Price is $133.69 |  Price is $20.09 |  Price is $34.09 |  Price is $101.39 | |
| Reviews | |||||
| Delivery Information | Delivery by Thu, Nov 26 | Free delivery by Mon, Nov 23 | Delivery by Wed, Nov 25 | Delivery by Tue, Nov 17 | Free delivery by Wed, Nov 25 |
| Available in my store | No | No | No | No | No |
| Medical Form Pack Size | 500 | 2500 | 100 | 250 | 25 |
| Length in Inches | 11 | 11 | 11 | 11 | 11.75 |
| Width in Inches | 8.5 | 8.5 | 8.5 | 8.5 | 9.375 |
| Medical Form Type | Health Insurance Claims | Dental Claims | Privacy Practice | Health Insurance Claims | Medical Records Folders |
| Print Type | Laser | Laser | Data not available | Laser | Data not available |
| Acid Free | Acid Free | Acid Free | Data not available | Data not available | Data not available |
| Add To Cart | Add To Cart | Add To Cart | Add To Cart |
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Page 1 of 2
Price is $15.99
Unit of measure 10/Pack
Delivery by Fri, Nov 20
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Price is $62.19
Unit of measure 25/Pack
Free delivery by Fri, Nov 20
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Price is $18.79
Unit of measure 25/Pack
Delivery by Fri, Nov 20
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Price is $60.99
Unit of measure 25/Pack
Free delivery by Fri, Nov 20
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Price is $83.79
Unit of measure 500/Box
Free delivery by Fri, Nov 20
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