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Product Information for Tops UB-04 Hospital Claim Form
Highlights for Tops UB-04 Hospital Claim Form
- Media Quantity:(1 Form Per Sheet)
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.