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UB-04 Laser Claim Forms

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Item UB-04

Availability: In stock.

Count Price Qty

UB-04 Claim Forms Laser 125 Count

Price

$19.95

UB-04 Claim Forms Laser 500 Count

Price

$39.95

UB-04 Claim Forms Laser 2500 Count

Price

$99.95

UB-04 Claim Forms Laser 5000 Count

Price

$179.95

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All Claim Forms Ship via FREE Ground Shipping (delivery in 2-5 business days).

The UB04 form (CMS 1450) is the uniform bill for institutional healthcare providers, replacing the UB92 form on May 23rd, 2007. The UB04 data set accommodates the National Provider Identifier (NPI) and other improvements.
 

The blank UB04 form is difficult to complete without the Uniform Billing Editor, the best UB04 instructions for helping providers complete UB04 forms.

All Claim Forms Ship via FREE Ground Shipping (delivery in 2-5 business days).

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