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.
General InformationProduct Type: Claim FormManufacturer Part Number: 59770RManufacturer Website Address: www.tops-products.comPackaged Quantity: 2500 / CartonManufacturer: Tops ProductsProduct Model: UB-04Product Name: UB-04 Hospital Claim FormBrand Name: Tops
Product InformationColor: WhiteMedia Quantity: (1 Form Per Sheet)Print Technology: Dot MatrixPrint: Front Side Form With Red InkForm Size: 11" Length x 8.50" WidthNumber of Parts: 1 Part
Tops UB-04 Hospital Claim Form
1 Part - 11" x 8.5" Form Size - 2500 / Carton