SKU: N1AUB04
UB-04 Claim Form, CMS-1450 Hospital Claim Form, 8-1/2 x 11" Pack of 500
$20.99
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- UB-04 Hospital Claim Form - CMS-1450
- Approved OMB No. 0938-0997
- 1 Part - 11" x 8.5" - Laser & Inkjet Compatible
UB-04 Claim Form, CMS-1450 Hospital Claim Form, 8-1/2 x 11" Pack of 500. Approved OMB No. 0938-0997. UB-04 laser-cut forms are designed for medical offices to file a claim with the patient's insurance company. Forms are printed to GPO standards in OCR ink on 20 lb. bond. The Health Care Finance Administration format ensures accuracy in reporting all necessary information. Forms meet the requirements of the Centers for Medicare and Medicaid Services (CMS). Laser and inkjet compatible. Replaces the UB-92 form.
