NNTCG3
-

TOPS Tops UB-04 Hospital Claim Form
1 Part - 11" x 8.5" Form Size - 2500 / Carton

Item Number: TOP59870R

Package Size: 1 Carton of 2500 Each
UB-04 laser-cut forms are designed for medical offices to file a claim with the patient's insurance company
List Price $198.36
You Pay: $186.80
Delivery estimate: 7/31/2014
Quantity
Additional Product Views:
<
>
Additional Product Options:
<
CloseAll Options
Tops UB-04 Hospital Claim Form - 1 Part - 11" x 8.5" Form Size - 2500 / Carton
>
Description Specifications Reviews
  • 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.

Shipping Weight: 26 lbs.

Certifications & StandardsAmerican Medical Association
ColorWhite
Form Quantity2500
Form Size11" Length x 8.50" Width
Form Size (W x H)8 1/2 in x 11 in
Form Special FeaturesFor Laser Printers
Forms Per Page1
Global Product TypeForms-Insurance Claim
LayoutOne Form per Sheet
Media Quantity(1 Form Per Sheet)
Number of Parts1 Part
Paper Color(s)Red, White
Paper Stock20-lb.
PrintFront Side Form With Red Ink
Print and Ruling Color(s)Red
Print TechnologyLaser
Printer CompatibilityLaser
Product ModelUB-04
Product NameUB-04 Hospital Claim Form
Product TypeClaim Form
Close this window

-
Copyright © 2000-2014, eofficedirect.com, LLC.