UB04 hospital forms & envelopes

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UB04 Hospital Forms & Envelopes for 1 part, 2 part and laser format plus a jumbo envelope that holds over 50 claims.

	UB-04 Hospital Claim Form-Laser Format
	Health plans, clearinghouses, and other information support vendors must be ready to handle and accept the new UB-04 Laser Billing Form
	Medetrac Price: $59.95

	UB-04 Hospital Claim Form -2 Part Continuous
	The UB-04 Hospital Claim Form -2 Part Continuous form is deigned for hospitals to file a medical claim with the patient’s insurance carrier. Our UB-04 hospital Claim Forms are available in a laser-cut sheet and one-to five-part continuous forms printed in OCR ‘dropout” red Ink with all copies on high quality white paper.
	Medetrac Price: $59.95

	UB-04 Hospital Claim Form-1 Part Continuous
	The UB04 1 Part Continuous form is deigned for hospitals to file a medical claim with the patient’s insurance carrier. are printed in OCR ‘dropout” red Ink with all copies on high quality white paper.
	Medetrac Price: $59.95

	The UB04 Jumbo Hospital Claim Envelope
	These Jumbo UB04 Left Window envelopes (28-LB. holds up to 50 claim forms.
	Medetrac Price: $31.00