About

Description
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.
Specs
Manufacturer # UB04LC
Acid Free Yes
Binding Type Cut-Flush
Brand Name ComplyRight
Claim Type Medical
Color (ink) Black
Double Sided No
Eco Label Standard SFI Certified Fiber Sourcing
Manufacturer TAX FORMS PRINTING, INC.
Number of Parts 1
Printer Compatibility Inkjet Printer; Laser Printer
Description
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.
Attribute Name Attribute Value
ComplyRight by ComplyRight UB04LC

ComplyRight UB04 Hospital Claim Laser Cut Forms, 1-Part, Box Of 2,500

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