CMS 1500 (HCFA 1500) and UB-04 (UB92) 1 part continuous 2500 SHEETS PER CASE According to CMS, a CMS 1500 (HCFA 1500) form is used by non-institutional providers to bill Medicare Part B covered services and some Medicaid services. UB-04 (UB-92) forms are generally used for Medicare Part A services. Some private insurance carriers may also accept claims filed on CMS 1500 (HCFA 1500) forms. GROUND FREIGHT PAID WITHIN THE 48 CONTIGUOUS UNITED STATES - FOR EXPEDITED OR SPECIALTY SHIPPING COSTS MUST BE CALCULATED SEPARATELY - ANY QUESTIONS CALL 800-841-0200 (If you are outside the 48 contiguous United States please call 800-841-0200 or 912-437-3192 to place your order - shipping costs for you must be calculated separately.) IF YOU CAN'T FIND YOUR PRODUCT HERE OR IF YOU NEED LARGE QUANTITY PRICING CALL 800-841-0200 NICE PEOPLE ANSWER THE PHONE (with possibly 1 exception!) BE SURE TO BOOKMARK THIS PAGE FOR YOUR RETURN VISIT :) CMS1500 (HCFA1500) 1 PART CONTINUOUS (CASE)2500 SHEETS PER CASE 1 PART CMS1500 (31-0901)$44.80, 3/$127.80, 8/$328.00, 10/$398.00 UB-04(UB92) 1 PART CONTINUOUS (CASE)2500 SHEETS PER CASE 1 PART UB-04 (31-0977)$44.80, 3/$127.80, 8/$328.00, 10/$398.00 MEDICAL CLAIM FORM ENVELOPES RETURN