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UB-04 Hospital Claim Form (UB04CF)
UB-04 Hospital Claim Form (UB04CF)
 



Product Code: UB04CF

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Description
 
The UB04 Hospital Claim Form contains a number of improvements and enhancements that include better alignment with the electronic HIPAA ASC X12N 837-Institutional Transaction Standard.
Specifications
  • UB-04 Hospital Claim Form (UB04CF)

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ME State Estimate Tax Envelope - 3-7/8" x 8-7/8" (MEEST10)
1099-INT Interest Income - Copy B Recipient (BINTREC05) (BINTREC05)
GA State Estimate Tax Envelope - 3-7/8" x 8-7/8" (GAEST10)
WI State Estimate Tax Envelope - 3-7/8" x 8-7/8" (WIEST10)
RI State Estimate Tax Envelope - 3-7/8" x 8-7/8" (RIEST10)