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
Frequently bought together
Price is $11.59, Regular price was $14.49, You save 20%
Unit of measure 24/Pack Price per unit $0.48/Wipe
Next-Day Delivery by tomorrow
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Price is $16.39
Unit of measure 6/Pack Price per unit $2.73/Roll
Next-Day Delivery by tomorrow
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Price is $4.59
Unit of measure 2/Pack Price per unit $2.30/Refill
Next-Day Delivery by tomorrow
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Price is $35.99
Unit of measure 100/Box Price per unit $0.36/Envelope
Free Next-Day eligible by tomorrow
30-min pickup
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Price is $19.99, Regular price was $26.79, You save 25%
Unit of measure 100/Box Price per unit $0.20/Envelope
Next-Day Delivery by tomorrow
30-min pickup
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Compare similar items
| 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 ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5) Price is $29.39 |  Price is $66.89 |  Price is $16.79 |  Price is $34.09 |  Price is $165.79 | |
| Reviews | |||||
| 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 |
Featured Products
Price is $17.89
Delivery by Thu, Nov 06
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Price is $20.19
Delivery by Thu, Nov 06
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Over 30
Price is $15.09
Unit of measure 50/Pack
Delivery by Mon, Nov 03
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Price is $166.39
Free delivery by Thu, Nov 06
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Price is $26.49
Unit of measure 50/Pack
Delivery by Mon, Nov 03
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Price is $21.89
Unit of measure 25/Pack
Delivery by Mon, Nov 03
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Price is $26.49
Unit of measure 50/Pack
Delivery by Mon, Nov 03
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Price is $16.49
Unit of measure 100/Pack
Delivery by Mon, Nov 03
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Price is $21.69
Delivery by Thu, Nov 06
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Over 30
Price is $52.19
Unit of measure 50/Pack
Free delivery by Thu, Nov 06
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Price is $45.79
Unit of measure 50/Pack
Free delivery by Mon, Nov 03
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Price is $21.95
Delivery by Thu, Nov 06
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Price is $57.29
Unit of measure 50/Pack
Free delivery by Mon, Nov 03
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Price is $24.99
Unit of measure 50/Pack
Delivery by Mon, Nov 03
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Price is $75.89
Unit of measure 50/Pack
Free delivery by Mon, Nov 03
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