UB-92, HCFA 1450 Medical Claim Forms
 

UB FORMS is a division of American HCFA Forms and DFL Enterprises , nationwide suppliers of CMS FORMS, HCFA FORMS and UB04 HEALTH INSURANCE CLAIM FORMS.
"Selling Direct to You on the Internet Since 1998"

 

Order UB 92, HCFA-1450 forms, CMS-1450 forms by phone
Order UB 92, HCFA-1450 forms, CMS-1450 forms secure online

CLAIM FORMS STARTING AT $19.99
We Have the NEWEST REVISION of CMS-1500 FORMS (02/12 Version) (STARTING AT $19.99)
We Have the
New UB-04 CLAIM FORMS (STARTING AT $19.99)

 

UB04 FORMS (Replaces UB92 Forms)

 

 

CMS-1500 FORMS (NEWEST REVISION - 02/12 Version)

 

 

CMS-1500 FORMS (HCFA-1500 Forms 08/05 Version)

 

 

CLAIM FORM ENVELOPES (CMS/HCFA 1500, UB-04)

 

MORE MEDICAL OFFICE FORMS & PRODUCTS FROM OUR ON-LINE STORE

HIPAA COMPLIANCE FORMS
HIPAA Information

HIPAA Compliant Confidential Patient Sign-In System

HIPAA Compliant Confidential Patient Sign-In System with adhesive strips
(HIP02) Blue
(HIP02GN) Green
(HIP02BY) Burgundy
(HIP04) Bi-Lingual, English/Spanish

Confidential Sign-In Logs (Generic)

HIPAA Employee Training Record
(Form #101)


HIPAA Practice Training Record
(Form #102)


Protected Health Information (PHI) Access Log
(Form #103)


Protected Health Information (PHI) Disclosure Log
(Form #104)


Patient Request for Amendment of Health Information
(Form #105)

 

HIPAA COMPLIANCE FORMS
Patient Requests for Accounting of Disclosures
(Form # 106)


Patient Request to Inspect/Review PHI
(Form #107)


Patient Request for Confidential Communications
(Form #108)


Patient Request for Restrictions on Use & Disclosure of PHI
(Form #109)


PHI Tracking Log
(Form #110)


Authorization to Release Information
(Form #111)


Notice of Privacy Practices
(Form #120)


Notice of Privacy Practices
Spanish Version
(Form #120S)

 

NARCOTIC CONTROL RECORDS
Drug Administration Records
with Pharmacy Receipts
(DNC10)


Drug Administration Records
with Pharmacy Receipts
(DNC25)


Controlled Drug Administration Records
(D150-10)


Controlled Drug Administration Records
(D150-25)


Controlled Drug Administration Records
(D250-10)


Controlled Drug Administration Records
(D250-25)


ENVELOPES

Claim Form Envelopes

Dental X-Ray Envelopes

Patient Valuables Envelopes

LABORATORY MOUNT SHEETS
Physician's Telephone Orders (DTO4)

Physician's Telephone Messages (DTM4)

Laboratory Reports (DC5)

Laboratory Reports (DD5)

Laboratory Reports (DVT3)

Laboratory Reports (DVT5)

Laboratory Reports (DVT13)

Laboratory Reports (DVT5)

Laboratory Reports (DH3)

Laboratory Reports (DH5)

PHYSICIAN'S ORDER SHEETS
Physician's Order Sheets (DPO3)

Physician's Order Sheets (DPO4)

Physician's Order Sheets (DPO5)
 

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.
UB Forms and American HCFA Forms are divisions of DFL Enterprises, Inc., an independent supplier of US Government approved claim forms and NOT an affiliate of CMS (
www.cms.gov)

 

 

UB04 FORMS (UB04 Forms replace UB92 Forms)

 

UB 04 Forms Laser Cut

Individual Sheets

UB 04 Forms Continuous

Continuous

CLICK IMAGE TO ENLARGE

TOP OF PAGE

TOP OF PAGE

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

Description
UB04
CLAIM FORMS
(Replaces UB92)

Qty./
Case

Price/
Case

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.

 

CMS-1500 CLAIM FORMS - NEWEST REVISION - 02/12 Version
(Replaces 08/05 Version of CMS-1500 Forms)

 

Individual Sheets

Continuous

CLICK IMAGE TO ENLARGE

TOP OF PAGE

TOP OF PAGE

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

Description
CMS 1500 (HCFA 1500) CLAIM FORMS
(Newest Revision)

Qty./
Case

Price/
Case

CLICK HERE TO

Individual Sheets

500

$19.99

Individual Sheets

2500

$35.00

1 Part Continuous

2500

$35.00

2 Part Continuous
1st Sheet White
2nd Sheet White

1000

$42.95

2 Part Continuous
1st Sheet White
2nd Sheet Canary

1000

$42.95

Discounts available for large quantities. Contract pricing available. Call for details.

 

CMS-1500 (HCFA-1500) CLAIM FORMS - 08/05 Version

 

CMS 1500, HCFA 1500 Forms Laser Cut

Individual Sheets

CMS 1500, HCFA 1500 Forms Continuous

Continuous

CMS 1500, HCFA 1500 Forms Snapout

Snapout

CLICK IMAGE TO ENLARGE

TOP OF PAGE

TOP OF PAGE

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

Description
CMS 1500 (HCFA 1500) CLAIM FORMS
(Version 08/05)

Qty./
Case

Price/
Case

CLICK HERE TO

Individual Sheets

500

$19.99

Individual Sheets

2500

$35.00

1 Part Continuous

2500

$35.00

2 Part Continuous
1st Sheet White,
2nd Sheet White

1000

$42.95

2 Part Continuous
1st Sheet White,
2nd Sheet Canary

1000

$42.95

SNAPOUT Version

500

$35.00

Discounts available for large quantities. Contract pricing available. Call for details.

 

 

HCFA/CMS 1500, UB-04 CLAIM FORM ENVELOPES

 

HCFA, CMS form envelopes
TOP OF PAGE

TOP OF PAGE

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

Description
CMS/HCFA 1500 CLAIM FORM ENVELOPES

Qty./
Case

Price/
Case

CLICK HERE TO

#10 (9-1/2" x 4-1/8") Right Window
ITEM # D38

500

$29.20

NEW! Printed Envelopes with Your Return Address
#10 (9-1/2" x 4-1/8") Right Window
ITEM # DI38

500

$48.00

These envelopes are available in right hand window only.
All envelopes are self-seal and have security liner
.

Your return address can be imprinted in the upper left.
Call for imprinting details. 1-877-840-1500

Description
CMS/HCFA 1500 CLAIM FORM ENVELOPES

Qty./
Case

Price/
Case

CLICK HERE TO

9" x 12.5" Right Window
ITEM # D36

500

$89.60

These envelopes are available in right hand window only.
All envelopes are self-seal and have security liner.

Your return address can be imprinted in the upper left.
Call for imprinting details. 1-877-840-1500

CLICK IMAGE TO ENLARGE

NEW! - New envelope for the UB04 claim form - NEW!

Description
UB 04 CLAIM FORM ENVELOPES

Qty./
Case

Price/
Case

CLICK HERE TO

 9"x 5-13/16"
ITEM # DUBENVMED

500

$63.73

New envelope for the UB04 claim form. Simply fold the UB04 in half and insert! The envelope has an inside tint for HIPAA compliance and moistenable gum flap. The size is 9"x 5-13/16".
 
Your return address can be imprinted in the upper left.
Call for imprinting details. 1-877-840-1500

Description
UB 04 CLAIM FORM ENVELOPES

Qty./
Case

Price/
Case

CLICK HERE TO

#10 (9-1/2" x 4-1/8") Self Seal Envelope
for UB 04, Left Window
ITEM # DUBENV10
NOT SELF-SEAL

500

$29.20

Inside tint for HIPAA compliance.

These envelopes are available in left hand window only.
All envelopes have security liner
.

Your return address can be imprinted in the upper left.
Call for imprinting details. 1-877-840-1500

Description
UB 04 CLAIM FORM ENVELOPES

Qty./
Case

Price/
Case

CLICK HERE TO

9" x 12.5" Left Window for UB-04
ITEM # DUB04CAT

500

$89.60

These envelopes are available in left hand window only.
All envelopes are self-seal and have security liner.

Your return address can be imprinted in the upper left.
Call for imprinting details. 1-877-840-1500

CLICK IMAGE TO ENLARGE

Order UB 92, HCFA-1450 forms, CMS-1450 forms by phone
Order UB 92 forms secure

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124 Pine Oak Dr.
Covington, LA 70433
PHONE: 985-875-0800
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UB04  |  CMS/HCFA 1500  |  UB04 FORMS

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UB04 forms, UB-04 forms, UB 04 forms, HCFA-1500 forms, CMS-1500 forms, HCFA forms, CMS forms, HCFA 1500 forms, CMS 1500 forms

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american hcfa forms.com
claim forms depot.com
dfl-enterprises.com
hipaa sign-in.com
hcfa1500forms.com
discountclaimforms.com

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