UB-04 TWO PART CONTINUOUS FORMS FOR DOT MATRIX OR PINFEED PRINTERS

UB-04 (UB92) 2 part continuous

1000 SETS PER CASE

According to CMS, a CMS 1500 (HCFA 1500) form is used by non-institutional providers to bill Medicare Part B covered services and some Medicaid services. UB-04 (UB-92) forms are generally used for Medicare Part A services. Some private insurance carriers may also accept claims filed on CMS 1500 (HCFA 1500) forms.

GROUND FREIGHT PAID WITHIN THE 48 CONTIGUOUS UNITED STATES - FOR EXPEDITED OR SPECIALTY SHIPPING COSTS MUST BE CALCULATED SEPARATELY - ANY QUESTIONS CALL 800-841-0200

(If you are outside the 48 contiguous United States please call 800-841-0200 or 912-437-3192 to place your order - shipping costs for you must be calculated separately.)

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