UB-04 THREE PART CONTINUOUS FORMS FOR DOT MATRIX OR PINFEED PRINTERS

UB-04 (UB92) 3 part continuous

500 SETS PER CASE

According to CMS, a CMS 1500 (HCFA 1500) form is used by non-institutional providers to bill Medicare Part B covered services and some Medicaid services. UB-04 (UB-92) forms are generally used for Medicare Part A services. Some private insurance carriers may also accept claims filed on CMS 1500 (HCFA 1500) forms.

GROUND FREIGHT PAID WITHIN THE 48 CONTIGUOUS UNITED STATES - FOR EXPEDITED OR SPECIALTY SHIPPING COSTS MUST BE CALCULATED SEPARATELY - ANY QUESTIONS CALL 800-841-0200

(If you are outside the 48 contiguous United States please call 800-841-0200 or 912-437-3192 to place your order - shipping costs for you must be calculated separately.)

IF YOU CAN'T FIND YOUR PRODUCT HERE OR IF YOU NEED LARGE QUANTITY PRICING CALL 800-841-0200

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UB-04 3 PART CONTINUOUS500 SETS PER CASE

3 PART UB04 (31-0973)$44.00, 3/$128.40, 8/$336.00, 10/$400.00
MEDICAL CLAIM FORM ENVELOPES
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