TOPS 1-part UB-04 Laser-cut Forms (TOP59870R)
TOPS 1-part UB-04 Laser-cut Forms (TOP59870R)
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1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton
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In Stock
Product Description
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.
Product Features
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Continuous forms are designed for hospitals to file a claim with the patient's insurance company
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Forms are printed to GPO standards in OCR ink on 20 lb. bond
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Health Care Finance Administration format ensures accuracy in reporting all necessary information
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11" Length x 8.50" Width; 2500 / Carton
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Replaces the UB-92
Product Specs
Manufacturer
TOPSManufacturer Stock No.
59870RMPN
TOP59870RModel#
59870RUPC Code
818275954726UNSPSC Code
0Brand Name
TOPSCountry of Origin
United StatesEnvironmental Certification
Sustainable Forestry Initiative (SFI)Form Length
11"Form Width
8.50"Manufacturer
TOPS ProductsManufacturer Part Number
59870RManufacturer Website Address
http://www.tops-products.comNumber of Parts
1Packaged Quantity
2500 / CartonPrint Color
RedPrinted Side
FrontProduct Model
UB-04Product Name
1-part UB-04 Laser-cut FormsProduct Type
Claim FormRecycled
NoAssembly Required
No assembly is requiredContains Recycled Materials
NReturnable
NoUnit of Measure
CTItem Weight
26Ships via UPS
YThis item is sold by the
CTBrand
TOPSCountry of Origin
USUNSPSC Number
14111804
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TOPS 1-part UB-04 Laser-cut Forms (TOP59870R) Reviews
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