Tops UB-04 Continuous Billing Form
2 Part - Carbonless - 11" x 9.5" Form Size - 1000 / Carton
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- Mfg Part No.
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Product Information for Tops UB-04 Continuous Billing Form
Highlights for Tops UB-04 Continuous Billing Form
UB-04 continuous forms are designed for hospitals 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.
General InformationProduct Type: Claim FormManufacturer Part Number: 59772RManufacturer Website Address: www.tops-products.comPackaged Quantity: 1000 / CartonManufacturer: TopsProduct Model: UB-04Product Name: UB-04 Continuous Billing FormBrand Name: Tops
Certifications & Standards
Medicare and Medicaid Services
Physical CharacteristicsWeight (Approximate): 19 lb
Product InformationColor: WhiteFeatures: PerforatedPrint Technology: LaserPrint: Front Side Form With Black InkForm Size: 11" Length x 9.50" WidthNumber of Parts: 2 PartCopy Type: Carbonless