UB04 Insurance Claim Form, 1-Part Continuous White, 9 1/2 x 11, 2500 Forms

Product ID:

190864

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$141.32 / CT
$127.45 / CT
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List Price: $160.46
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  • Expedite Medicare, Medicaid or private insurance claims processing.
  • Forms meet all Federal regulations.
  • Formerly known as HCFA-1500 forms.

Expedite Medicare, Medicaid or private insurance claims processing. Forms meet all Federal regulations. Formerly known as HCFA-1500 forms.

Includes 2,500 forms.

Specifications

Copy Types Continuous Feed
Form Quantity 2500
Forms Per Page 1
Global Product Type Forms-Insurance
Paper Color White
Paper Stock 20 lb.
Sheet Size 9 1/2 x 11
Special Features UB04 Hospital Insurance Claim Forms
Form Size 9 1/2 x 11
Footnote 1 One-part continuous feed, white
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