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TOPS UB-04 Continuous Billing Form 2 Part - Carbonless - 11" x 9.50" Form Size - 1000 / Carton

TOPS UB-04 Continuous Billing Form TOP59772R
Item #: TOP59772R
List Price $151.67 Your Price $108.81 / CT You Save $42.86 - 28%
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Product Description

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.

General Information

General Information

ManufacturerTOPS Products
Manufacturer Part Number59772R
Manufacturer Website Addresshttp://www.tops-products.com
Brand NameTOPS
Product ModelUB-04
Product NameUB-04 Continuous Billing Form
Packaged Quantity1000 / Carton
Product TypeClaim Form

Product Information

Form Size11" Length x 9.50" Width
Number of Parts2 Part
Copy TypeCarbonless
PrintFront Side Form With Black Ink
Print TechnologyLaser

Physical Characteristics

Weight (Approximate)19 lb


Certifications & Standards

Medicare and Medicaid Services

Recycled Content0%
Assembly RequiredNo
Country of OriginUnited States


Customer Reviews

Customer Reviews

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TOPS UB-04 Hospital Claim Form TOP59770R
1 Part - 11" x 9.50" Form Size - 2500 / Carton

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