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4 products, 1 page

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$124.84
1 Part - 11" x 8.50" Form Size - Red Print Color - 2500 / Carton
  • Replaces the UB-92
  • 11" Length x 8.50" Width; 2500 / Carton
  • Health Care Finance Administration format ensures accuracy in reporting all necessary information
  • Forms are printed to GPO standards in OCR ink on 20 lb. bond
  • Continuous forms are designed for hospitals to file a claim with the patient's insurance company
We have 140 available for immediate delivery.
THIS ITEM SHIPS FOR FREE!
$108.95
1 Part - 11" x 9.50" Form Size - Red Print Color - 2500 / Carton
  • 9-1/2" x 11"
  • Health Care Finance Administration format ensures accuracy in reporting all necessary information
  • UB-04 1-part continuous is a form that hospitals use to file a claim with the patient's insurance company
  • Forms are printed to GPO standards in OCR ink on 20 lb. bond
We have 69 available for immediate delivery.
THIS ITEM SHIPS FOR FREE!
$120.02
2 Part - Carbonless Copy - 8 1/2" x 11" Sheet Size - White Sheet(s) - Red Print Color - 1500 / Carton
  • Meets requirements of Champus and the AMA Council of Medical Service
  • Meets requirements of the Centers for Medicare and Medicaid Services
  • Complies with current physicians' standards for expediting Medicare and Medicaid payments
  • Printed in OCR red ink for scanning
  • Approved by NUCC
We have 7 available for immediate delivery.
THIS ITEM SHIPS FOR FREE!
$6.89
20 lb - Letter - 8 1/2" x 11" Sheet Size - White Sheet(s) - 1 Each
  • Meets all requirements of Centers for Medicare and Medicaid Services
  • Use for Medicare, Medicaid or private insurance claims
  • Laser-cut sheets are cut to letter size for convenient use
  • Ready-to-use design speeds up insurance claims processing
We have 4 available for immediate delivery.

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