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TOPS 1-part UB-04 Laser-cut Forms – TOP59870R
$146.00
$343.15
TOPS 1-part UB-04 Laser-cut FormsUPC: 818237890116,818275954726Marketing Information: 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 accurac
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TOPS 1-part UB-04 Laser-cut Forms
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.
General Information
- Manufacturer: TOPS Products
- Manufacturer Part Number: 59870R
- Manufacturer Website Address: http://www.tops-products.com
- Brand Name: TOPS
- Product Model: UB-04
- Product Name: 1-part UB-04 Laser-cut Forms
- Packaged Quantity: 2500 / Carton
- Product Type: Claim Form
Product Information
- Number of Forms per Sheet: 1
- Form Length: 11″
- Form Width: 8.50″
- Number of Parts: 1
- Printed Side: Front
- Print Color: Red
- Print Technology: Laser
Physical Characteristics
- Product Color: White
Miscellaneous
- Certifications & Standards:
American Medical Association
- Recycled: No
- Assembly Required: No
- Environmental Certification: SFI
- Country of Origin: United States
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