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Pack of 2,500 Forms

KWD 16
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Special Features

  • HEALTH INSURANCE CLAIM FORM: Reduce Billing Errors with UB-04 Health Insurance Claim Forms for use by hospitals and institutions
  • COMPLIANT: 100% compliant with HIPAA regulations
  • CLAIM FORM: Designed for hospitals to file a medical claim with the patient's insurance carrier, Form UB-04 is printed with OCR “dropout” red ink on 20# paper. All parts printed on white carbonless stock
  • PACKAGING/DIMENSIONS: Laset Cut Sheet. 8-1/2" x 11". Pack of 2,500.
  • COMPLYRIGHT: At ComplyRight, our mission is to free employers from the burden of tracking and complying with the complex web of federal, state, and local employment laws. ComplyRight is the market leader in government compliant products such as tax forms, tax software, HR products and services, labor law solutions, and health insurance claim forms.

Description

Reduce Billing Errors with UB-04 Health Insurance Claim Forms for use by hospitals and institutions. Designed for hospitals to file a medical claim with the patient's insurance carrier, Form UB-04 is printed with OCR “dropout” red ink on 20# paper. All parts printed on white carbonless stock. Laset Cut Sheet. 8-1/2" x 11". Pack of 500.

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