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HCFA/CMS 1500 Forms
OMB approved, NEW 02/12 version.

Laser and pinfeed styles

SALE! 2,500 laser sheets:  

$39.95

    

 $20 off your online      order of $100 or more.

Limited time offer. Amount deducted prior to charge

$40 off your online order of $200 or more.

Limited time offer. Amount deducted prior to charge

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UB-04 Claim Form Laser

SKU: 987 $12.95
Mandatory by May 23, 2007!
NEW UB-04 Claim Form for Laser and Inkjet printers. Medicare approved for billing Medicare Part A claims. Replaces UB-92. The new UB-04 forms will be effective for optional use starting March 1, 2007 through May 23, 2007-but will be required starting May 23, 2007.
-Printed in red, OCR scannable ink in compliance with government standards
-8-1/2"x11"
-1Part form
-20lb. paper