AMERICAN HCFA FORMS

YOUR BEST AND FASTEST SOURCE FOR CMS, UB04, HCFA HEALTH INSURANCE CLAIM FORMS

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 UB04 CLAIM FORMS  (New UB04 form replaces UB92 form)

UB04 CLAIM FORMS
AVAILABLE IN EITHER INDIVIDUAL SHEETS OR ONE OR TWO-PART CONTINUOUS (PINFEED) FORMS ON HIGH-QUALITY PAPER TO GOVERNMENT STANDARDS.

UB 04 Forms Laser Cut

Individual Sheets

UB 04 Forms Continuous

Continuous

CLICK IMAGES TO ENLARGE

Description
UB04
 CLAIM FORMS
(Replaces UB92)

Quantity/
Case

Price/
Case

TO ORDER
CONTACT US
TOLL FREE AT:
1-877-840-1500
8-5 Mon-Fri CST
OR

CLICK HERE TO

Individual
Sheets

500

$19.99

Individual
Sheets

2500

$35.00

1 Part Continuous

2500

$35.00

2 Part Continuous

1000

$42.95

Discounts available for large quantities.  Contract pricing available.  Call for details.1-877-840-1500

ALL OUR FORMS ARE OF THE HIGHEST QUALITY, ARE PRINTED IN STRICT COMPLIANCE WITH GOVERNMENT SPECIFICATIONS AND ARE APPROVED BY CENTERS FOR MEDICARE AND MEDICAID SERVICES AND THE INSURANCE INDUSTRY.
OUR FORMS HAVE BEEN APPROVED BY THE GOVERNMENT
The American HCFA Forms division of DFL Enterprises, Inc. is an independent supplier of US Government approved claim forms and NOT an affiliate of CMS (www.cms.gov)

LOOKING FOR OTHER BUSINESS FORMS?
WE CAN HELP YOU WITH ALL YOUR BUSINESS FORM NEEDS!

TO ORDER CONTACT US TOLL FREE AT:

1-877-840-1500

OR BY FAX:    1-985-809-5788

Our Office Hours are:
  Monday - Thursday:  8am - 5pm CST
Friday:  8am - 12 noon CST

WE ACCEPT VISA, MASTERCARD
and AMERICAN EXPRESS

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Copyright © Since 1998 American HCFA Forms

124 Pine Oak Dr.
Covington, LA  70433
PHONE:  985-875-0800
E-MAIL US

Visit our Associated Websites
american hcfa forms.com
claim forms depot.com
dfl-enterprises.com
hipaa sign-in.com
UB92.net
discountclaimforms.com

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