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ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
$29.39
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ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)~#|#~BEEB25B0-3006-416D-A7EB845F6AB6205B_sc7
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
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ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)

Item #: 24614845Model #: UB04LC5
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$29.39

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ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)~#|#~BEEB25B0-3006-416D-A7EB845F6AB6205B_sc7
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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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    Product specifications table
    Attributes ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5) ComplyRight 2024 ADA Dental Claim Forms, 1,000 Forms/Pack (202411) ComplyRight Notice of Privacy Practice, 100/Pack (A1349) ComplyRight Confidential Employee Medical Records Folder, Pack of 25 (A2211) ComplyRight 2024 ADA Dental Claim Forms, 500 Forms/Pack (20241500)
    Your product
    ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
    Price is $29.39
    ComplyRight 2024 ADA Dental Claim Forms, 1,000 Forms/Pack (202411)~#|#~4A9BEC59-372C-4BA2-98230C384214A03F_sc7
    Price is $66.89
    ComplyRight Notice of Privacy Practice, 100/Pack (A1349)
    Price is $21.09
    ComplyRight Confidential Employee Medical Records Folder, Pack of 25 (A2211)
    Price is $165.79
    ComplyRight 2024 ADA Dental Claim Forms, 500 Forms/Pack (20241500)~#|#~8C5CF2B1-C564-4834-B70E58035F19DEAC_sc7
    Price is $43.59
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    Delivery Information
    Delivery by Thu, Mar 05
    Free delivery by Tue, Mar 03
    Delivery by Tue, Mar 03
    Free delivery by Tue, Mar 03
    Free delivery by Tue, Mar 03
    Available in my store
    No
    No
    No
    No
    No
    Medical Form Pack Size
    500
    1000
    100
    25
    500
    Medical Form Type
    Health Insurance Claims
    Dental Claims
    Privacy Practice
    Medical Records Folders
    Dental Claims
    Width in Inches
    8.5
    8.5
    8.5
    9.375
    8.5
    Length in Inches
    11
    11
    11
    11.75
    11
    Print Type
    Laser
    Laser
    Data not available
    Data not available
    Laser
    Acid Free
    Acid Free
    Acid Free
    Data not available
    Data not available
    Acid Free
    Price Per Unit
    Data not available
    Data not available
    Data not available
    Data not available
    Data not available
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    Add To Cart
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