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

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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)

Name: ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
Brand: ComplyRight
SKU: 24614845
Price: 29.39 USD
Availability: InStock

Item #: 24614845Model #: UB04LC5

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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, 500 Forms/Pack (20241500)	ComplyRight 2024 ADA Dental Claim Forms, 2,500 Forms/Pack (20241)	ComplyRight 2024 ADA Dental Claim Forms, 1,000 Forms/Pack (202411)	ComplyRight 2024 ADA Dental Claim Forms, 100 Forms/Pack (20241100)
	Your product ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5) Price is $29.39	Price is $43.59	Price is $133.69	Price is $66.89	Price is $16.79
Reviews	No reviews yet	No reviews yet	No reviews yet	No reviews yet	No reviews yet
Delivery Information	Delivery by Tue, Dec 02	Free delivery by Tue, Nov 25	Free delivery by Tue, Nov 25	Free delivery by Tue, Nov 25	Delivery by Tue, Nov 25
Available in my store	No	No	No	No	No
Medical Form Pack Size	500	500	2500	1000	100
Medical Form Type	Health Insurance Claims	Dental Claims	Dental Claims	Dental Claims	Dental Claims
Length in Inches	11	11	11	11	11
Width in Inches	8.5	8.5	8.5	8.5	8.5
Print Type	Laser	Laser	Laser	Laser	Laser
Acid Free	Acid Free	Acid Free	Acid Free	Acid Free	Acid Free
	Add To Cart	Add To Cart	Add To Cart	Add To Cart