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ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
$29.39
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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
$29.39

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Consider this similar product

TFP UB-04 CMS-1450 Health Insurance Claims, 2500/Carton (UB04LC)~#|#~s1172744_sc7
Price is $91.59
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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 2024 ADA Dental Claim Forms, 100 Forms/Pack (20241100) ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250) ComplyRight Confidential Employee Medical Records Folder, Pack of 25 (A2211)
    Your product
    Price is $29.39
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    4.7
    21
    Delivery Information
    Delivery by Fri, Nov 07
    Free delivery by Tue, Nov 04
    Delivery by Tue, Nov 04
    Next-Day Delivery by tomorrow
    Free delivery by Thu, Nov 06
    Available in my store
    No
    No
    No
    No
    No
    Medical Form Pack Size
    500
    1000
    100
    250
    25
    Width in Inches
    8.5
    8.5
    8.5
    8.5
    9.375
    Medical Form Type
    Health Insurance Claims
    Dental Claims
    Dental Claims
    Health Insurance Claims
    Medical Records Folders
    Length in Inches
    11
    11
    11
    11
    11.75
    Print Type
    Laser
    Laser
    Laser
    Laser
    Data not available
    Acid Free
    Acid Free
    Acid Free
    Acid Free
    Data not available
    Data not available
    Price Per Unit
    Data not available
    Data not available
    Data not available
    Data not available
    Data not available
    Add To Cart
    Add To Cart
    Add To Cart
    Add To Cart