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TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton
TOPSSKU TOP59870R

TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton

★ 4.5·0 reviews·UPC 818275954726
$283.38per CT
In stock — 39 available
Earn ~283 points · 2× for business accounts
Free shipping on orders over $99
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UPS shippable
Featured
  • Continuous forms are designed for hospitals to file a claim with the patient's insurance company
  • Forms are printed to GPO standards in OCR ink on 20 lb. bond
  • Health Care Finance Administration format ensures accuracy in reporting all necessary information
  • 11" Length x 8.50" Width; 2500 / Carton
  • Replaces the UB-92

UB-04 laser-cut forms are designed for medical offices to file a claim with the patient's insurance company. The Health Care Finance Administration format ensures accuracy in reporting all necessary information. Forms meet the requirements of the Centers for Medicare and Medicaid Services (CMS). Forms are printed on 20 lb. bond paper.

claim medical forms tops 1-part ub-04 laser-cut claim form products number of parts 1 length 11" width 8 50" sustainable forestry initiative (sfi) united states red
1
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30-day returns
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