Required for healthcare providers to bill a patient’s 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.
| Item # | 799126 |
| Manufacturer # | UB04LC |
| Color (Ink) | Black |
| sheet size | Letter (8-1/2″ x 11″) |
| printer compatibility | Inkjet Printer; Laser Printer |
| double sided | No |
| claim type | Medical |
| sensor bars | No |
| number of parts | 1 |
| acid free | Yes |
| Product Line | Hospital Claim Forms |
| binding type | Cut-Flush |
| quantity | 2500 |
| brand name | ComplyRight |
| Eco Label Standard | SFI Certified Fiber Sourcing |
| manufacturer | TAX FORMS PRINTING, INC. |
| Total Quantity | 2500 Medical Claim Forms |
| UPC | 094922030214 |















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