UB-04 (CMS 1450) Health Hospital Insurance Claim Form, Laser 8-1/2 x 11" 500 Per Pack;
UB-04 (CMS 1450) Health Hospital Insurance Claim Form, Laser 8-1/2 x 11

Pack of 500

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Pack of 500

  • UB-04 (CMS 1450) Health Insurance Claim Form
  • Laser / Ink-JetFormat
  • 1 Part 24# 8-1/2 x 11 (Letter Size)
  • Accommodates reporting of the National Provider Identifier (NPI) number
  • 100% compliant with the approved update to the HCFA / CMS1450 health claim form
  • UB-04 (CMS 1450) Health Insurance Claim Form
  • Laser / Ink-JetFormat
  • 1 Part 24# 8-1/2 x 11 (Letter Size)
  • Accommodates reporting of the National Provider Identifier (NPI) number
  • 100% compliant with the approved update to the HCFA / CMS1450 health claim form

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