Tops Products UB-04 Hospital Claim Form
$ 94.81 In Stock
Condition:
New
Item No.
746350
Mfg Part No.
59770R

Product Information for Tops Products UB-04 Hospital Claim Form

Highlights for Tops Products UB-04 Hospital Claim Form

  • Media Quantity:(1 Form Per Sheet)

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: 59770R
  • Manufacturer Website Address: www.tops-products.com
  • Packaged Quantity: 2500 / Carton
  • Manufacturer: Tops Products
  • Product Model: UB-04
  • Product Name: UB-04 Hospital Claim Form
  • Brand Name: Tops
  • Miscellaneous

    Recycled

    No

    Recycled Content

    0%

    Post-consumer-waste%

    0%

    Assembly Required

    No

    Physical Characteristics

    Product Information

  • Color: White
  • Media Quantity: (1 Form Per Sheet)
  • Print Technology: Dot Matrix
  • Print: Front Side Form With Red Ink
  • Form Size: 11" Length x 8.50" Width
  • Number of Parts: 1 Part