Ancom has designed and printed over 1,000 custom professional forms for our customers, including the Healthcare industry, whose offices have relied on our stock professional forms for years. At Ancom, you’ll find the ready-made forms that you need: HIPAA forms, HCFA forms, ADA forms, and Rx pads, along with X-Ray mailers, recall postcards, laser statements and mailing envelopes. To get started on designing your own custom professional form, see our Custom Forms section.
UB 04 Medical Claim Form - Four Part Continuous
New Format: Four Part Continuous Claim Form with space for NPI code, 9 1/2" W x 11" H (including pin feed), OCR red ink on white paper, 500 per carton.
National Provider Identifier (NPI) codes now required. Save time by pre-imprinting the doctor's name and NPI number on the forms. Envelopes available.
Ancom Business Products an InHealth Company