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Home > Office Supplies > Accounting Books > Tops UB-04 Continuous Billing Form

Tops UB-04 Continuous Billing Form

2 Part - Carbonless - 11" x 9.5" Form Size - 1000 / Carton

Tops UB-04 Continuous Billing Form
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Tops UB-04 Continuous Billing Form
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Item No.  718962
Mfg Part No.  59772R
Product Condition:  New
Manufacturer:  Tops

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30 Day Return Policy

Highlights for Tops UB-04 Continuous Billing Form

Marketing Information

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 Information

  • Product Type: Claim Form
  • Manufacturer Part Number: 59772R
  • Manufacturer Website Address: www.tops-products.com
  • Packaged Quantity: 1000 / Carton
  • Manufacturer: Tops
  • Product Model: UB-04
  • Product Name: UB-04 Continuous Billing Form
  • Brand Name: Tops
  • Miscellaneous

    Certifications & Standards

    Medicare and Medicaid Services



    Recycled Content




    Assembly Required


    Physical Characteristics

  • Weight (Approximate): 19 lb
  • Product Information

  • Color: White
  • Features: Perforated
  • Print Technology: Laser
  • Print: Front Side Form With Black Ink
  • Form Size: 11" Length x 9.50" Width
  • Number of Parts: 2 Part
  • Copy Type: Carbonless
  • Powered By GfK Etilize

    Tops UB-04 Continuous Billing Form

    2 Part - Carbonless - 11" x 9.5" Form Size - 1000 / Carton

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