Tops Products UB-04 Continuous Billing Form
$ 88.74 Not Available
Condition:
New
Item No.
718962
Mfg Part No.
59772R

Product Information for Tops Products UB-04 Continuous Billing Form

Highlights for Tops Products 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

    No

    Recycled Content

    0%

    Post-consumer-waste%

    0%

    Assembly Required

    No

    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