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SKU: 8379
$95.23
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TOPS - UB04 Hospital Insurance Claim Form, 8 1/2 x 11, 2,500 FormsPrinted to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format. Form Size: 8 1/2 x 11; Forms Per Page: 1.
- 2500 Forms / Carton
- UB04 Claim Forms For Laser Printers
- This is the NEW UB04 (HCFA 1450) adding the split provider identifier fields for NPI numbers
- 100% compatible with UCCI requirements
- Expedited shipping available
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