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TOPS 1-part UB-04 Laser-cut Forms

Brand: Tops

1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton

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

SKU: TOP59870R

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.

Products specifications

Product Name	1-part UB-04 Laser-cut Forms
Packaged Quantity	2500 / Carton
Manufacturer Part Number	59870R
Form Width	8.50"
Product Type	Claim Form
Printed Side	Front
Manufacturer Website Address	http://www.tops-products.com
Recycled	No
Print Color	Red
Brand Name	TOPS
Manufacturer	TOPS Products
Product Model	UB-04
Country of Origin	United States
Product Color	White
Number of Parts	1
Form Length	11"