ComplyRight UB04 Hospital Claim Laser Cut Forms, 1-Part, Box Of 2,500

Hospital Claim Form for Laser
SKU: 799126
$117.81
Required for healthcare providers to bill a patients insurance company for reimbursement of medical claims Forms must adhere to strict printing standards that govern the layout, paper and ink. Each form must have accurate content and conform to the Health Insurance Portability and Accountability Act (HIPAA). Developed in conjunction with all the governing agencies, including the National Uniform Claim Committee (NUCC), the National Uniform Billing Committee (NUBC), the CMS Centers for Medicare and Medicaid Services, the Health and Human Services Agency, and the American Hospital Association. Corresponding envelopes are sold separately.
Products specifications
Attribute nameAttribute value
brand nameComplyRight
Product LineHospital Claim Forms
double sidedNo
printer compatibilityInkjet Printer; Laser Printer
acid freeYes
Eco Label StandardSFI Certified Fiber Sourcing
number of parts1
quantity2500
sheet sizeLetter (8-1/2" x 11")
claim typeMedical
sensor barsNo
Color (Ink)Black
binding typeCut-Flush
manufacturerTAX FORMS PRINTING, INC.