Home >

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



Product Code: UB04CF

SELECT A QTY

QTY & PRICE (Scroll Down)*:


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)

Share your knowledge of this product with other customers... Be the first to write a review


1095-C Employer Provided Health Insurance (B1095C05)
W-2 Form - Copies B/2/C/2 (Employee) - 4up Ver. 2 for High-Speed Processing Equipment (B4DWNEMP)
1099-PATR Form - Copy B (Recipient) (BPATRRC05)
1099-S Form 4-part - 3up Self Mailer (QMS053)
GA State Estimate Tax Envelope - 3-7/8" x 8-7/8" (GAEST10)
Single Window Envelope - Moisture Seal - 4-1/8" x 9-1/2" (E1503)
REVISED GOOD FAITH ESTIMATE
4up Blank W-2 & 1099 Form - Quadrants (4UPPERF05)
RI State Estimate Tax Envelope - 3-7/8" x 8-7/8" (RIEST10)