https://www.staples-3p.com/s7/is/image/Staples/s1172744_sc7
TFP UB-04 CMS-1450 Health Insurance Claims, 2500/Carton (UB04LC)
$91.59
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
  • Designed for hospitals to file a medical claim with the patient's insurance carrier
  • One-part health insurance forms
  • Contains 2500 forms per carton

TFP UB-04 CMS-1450 Health Insurance Claims, 2500/Carton (UB04LC)

Item #: 519727Model #: UB04LC
Final price is $91.59
2500/carton
First time subscribers save 5% off your entire AutoRestock order! Save up to 10% on all following orders. Learn more

Free Returns

Online. In store. Always free.

Learn More

Sign in to unlock exclusive deals and picks just for you. sign in
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)~#|#~BEEB25B0-3006-416D-A7EB845F6AB6205B_sc7
No reviews yet
Price is $29.39
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Customers bought together
TFP UB-04 CMS-1450 Health Insurance Claims, 2500/Carton (UB04LC)~#|#~s1172744_sc7
TFP UB-04 CMS-1450 Health Insurance Claims, 2500/Carton (UB04LC) is Your Product
Price is $91.59
JAM Paper POP 2-Pocket Portfolio Plastic Folder, Lime Green, 96/Box (382ELIGRB)~#|#~m004858045_sc7JAM Paper POP 2-Pocket Portfolio Plastic Folder, Lime Green, 96/Box (382ELIGRB)~#|#~m004857879_sc7
Price is $237.29
Price for both
$328.88
  • 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
    • Contains 2500 forms per carton
    • 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

    Compare similar items

    Product specifications table
    Attributes TFP UB-04 CMS-1450 Health Insurance Claims, 2500/Carton (UB04LC) ComplyRight CMS-1500 Health Insurance Claims, 2500/Pack (CMS12LC) ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 1,000 (CMS12LC1) ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 500 (CMS12LC500) ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 250 (CMS12LC250)
    Your product
    Price is $91.59
    Reviews
    3.3
    3
    4.8
    58
    4.9
    42
    4.7
    31
    4.6
    25
    Delivery Information
    Free delivery by Wed, Nov 05
    Free delivery by Wed, Nov 05
    Free delivery by Thu, Oct 30
    Free delivery by Wed, Nov 05
    Delivery by Wed, Nov 05
    Available in my store
    No
    No
    No
    No
    No
    Medical Form Pack Size
    2500
    2500
    1000
    500
    250
    Medical Form Type
    Health Insurance Claims
    Health Insurance Claims
    Health Insurance Claims
    Health Insurance Claims
    Health Insurance Claims
    True Color
    White / Red
    White / Red
    White / Red
    White / Red
    White / Red
    Print Type
    Laser
    Laser
    Laser
    Laser
    Laser
    Number of Parts
    1
    1
    1
    1
    1
    Pack Qty
    250
    2500
    1000
    500
    250
    Series or Collection
    UB-04 CMS-1450
    CMS-1500
    Data not available
    Data not available
    Data not available
    Add To Cart
    Add To Cart
    Add To Cart
    Add To Cart