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 # | UB04LC5 |
| 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
UB04LC5
ComplyRight UB04 Hospital Claim Laser Cut Forms, 1-Part, Box Of 500
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