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MED-PASS:  The Fine Art of Document Design

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 you have any questions, please call MED-PASS at 1-800-438-8884.
MED-PASS offices will be closed Thursday, November 23 and Friday, November 24 in observance of the
Thanksgiving holiday. All orders placed after 2:00pm EST Wednesday will ship Monday, November 27

CMS 1450 Claim Form (UB-04), Laser, 1 part, White paper, Red (OCR) ink - 500/pack


Availability: In stock

Price: $17.95
  • Buy 2-4 for $15.00 each and save 17%
  • Buy 5-39 for $10.20 each and save 44%
  • Buy 40 or more for $9.50 each and save 48%
MED-PASS CMS claim forms are produced on high quality paper and printed in OCR red "drop out" ink to ensure efficient processing of claims. These claim forms are in strict compliance with government printing specifications.
  • The UB-04 is the new version of the CMS-1450 claim form which became mandatory for billing Medicare on May 23, 2007.
Unit Package of 500
Other Info Laser Printer Compatible

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