Highlights
View Details- 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
ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
Log in to see pricing
Same-day Shipping
This product usually ships and arrives up to 1 - 2 days
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
| Manufacturer # | UB04LC5 |
| Acid Free | Acid Free |
| Brand Name | ComplyRight |
| Length in Inches | 11 |
| Medical Form Pack Size | 500 |
| Medical Form Type | Health Insurance Claims |
| Print Type | Laser |
| Width in Inches | 8.5 |
Details
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
| Attribute Name | Attribute Value |
|---|
