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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$102.36
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
Frequently bought together
Page 1 of 4
Price is $17.09
Delivery by Wed, Sep 23
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Price is $146.69
Free delivery by Mon, Sep 21
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Price is $35.29
Unit of measure 10/Box
Free delivery by Tue, Sep 15
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Price is $56.79
Unit of measure 10/Box Price per unit $5.68/Folder
Free delivery by Tue, Sep 15
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Price is $19.39
Unit of measure 500/Ream
Delivery by Tue, Sep 15
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Compare similar items
| Attributes | ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5) | TFP UB-04 CMS-1450 Health Insurance Claims, 2500/Carton (UB04LC) | ComplyRight CMS-1500 Jumbo Health Care Billing Envelope, 500/Pack (1500LR500) | ComplyRight 2024 ADA Dental Claim Forms, 1,000 Forms/Pack (202411) | ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250) |
|---|---|---|---|---|---|
Your product ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5) Price is $30.19 |  Price is $93.89 |  Price is $146.69 |  Price is $66.89 |  Price is $34.09 | |
| Reviews | |||||
| Delivery Information | Delivery by Thu, Sep 24 | Free delivery by Mon, Sep 21 | Free delivery by Mon, Sep 21 | Free delivery by Mon, Sep 21 | Delivery by Tue, Sep 15 |
| Available in my store | No | No | No | No | No |
| Length in Inches | 11 | Data not available | Data not available | 11 | 11 |
| Width in Inches | 8.5 | Data not available | Data not available | 8.5 | 8.5 |
| Medical Form Pack Size | 500 | 2500 | 500 | 1000 | 250 |
| Medical Form Type | Health Insurance Claims | Health Insurance Claims | Health Insurance Claims | Dental Claims | Health Insurance Claims |
| Print Type | Laser | Laser | Data not available | Laser | Laser |
| Acid Free | Acid Free | Data not available | Data not available | Acid Free | Data not available |
| Add To Cart | Add To Cart | Add To Cart | Add To Cart |
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Page 1 of 3
Price is $15.59
Unit of measure 50/Pack
Delivery by Fri, Sep 18
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Price is $20.19
Delivery by Wed, Sep 23
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Price is $20.89
Unit of measure 25/Pack
Delivery by Fri, Sep 18
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Price is $12.69
Unit of measure 50/Pack
Delivery by Fri, Sep 18
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Price is $17.95
Delivery by Wed, Sep 23
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