UB04 Claim Forms/CMS 1450 (Model # IHNLCFUB041)
- 500 UB04 Claim Forms/CMS 1450/Order
- Single sheets for laser printers – UB04 version for all Part A Medicare claims
- Printed in OCR red scannable format with instructions on the back
- Available in 20 lb. bond paper
- Also available in one- or two-part clean carbon (NCR) continuous forms
$36.00
Additional information
| Weight | 5.2 lbs |
|---|
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