TOPS 1-part UB-04 Laser-cut Forms

Name: TOPS 1-part UB-04 Laser-cut Forms
SKU: TOP59870R
Availability: InStock

$312.26

1 Part – 11″ x 8.50″ Form Size – White – Red Print Color – 2500 / Carton

SKU: TOP59870R Category: Claim/Medical Forms Tag: claim, medical, forms, tops, 1-part, ub-04, laser-cut, form, products, number, of, parts, 1, length, 11, width, 8, 50, sustainable, forestry, initiative, sfi, united, states, red

Description
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UB-04 laser-cut forms are designed for medical offices 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.

Continuous forms are designed for hospitals to file a claim with the patient’s insurance company
Forms are printed to GPO standards in OCR ink on 20 lb. bond
Health Care Finance Administration format ensures accuracy in reporting all necessary information
11″ Length x 8.50″ Width; 2500 / Carton
Replaces the UB-92