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TOPS UB-04 Continuous Forms
TOPS UB-04 Continuous Forms - 1 Part - 11" x 9.50" Form Size - Red Print Color - 2500 / Carton
| $128.94 |
Manufacturer:
TOPS Products
Item:
59770R
Our Part #
TOP59770R
$128.94
Availability
In Stock
Product description
Specifications
Country of Origin
United States
Environmental Certification
SFI
Form Length
11"
Form Width
9.50"
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). Continuous forms are printed on 20 lb. bond paper.
Packaged Quantity
2500 / Carton
Print Color
Red
Print Technology
Dot Matrix
Product Model
UB-04
Product Type
Claim Form