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Supplies - Claim Forms
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| ST11843N | | | CMS 1450 Claim Form (UB-04), Continuous, 1 part, White paper, Red (OCR) ink | | | 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. | | | Features: | - The UB-04 is the new version of the CMS-1450 claim form which became mandatory for billing Medicare on May 23, 2007.
- A previous version of this claim form (UB-92) is still available for shipment. Contact MED-PASS customer service at 800-438-8884.
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| Specifications: | | CMS 1450 Claim Form (UB-04), Continuous, 1 part, White paper, Red (OCR) ink, 2500 per carton | |
| Click for information about our custom forms service | |
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