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- TOPS 1-part UB-04 Laser-cut Forms
TOPS 1-part UB-04 Laser-cut Forms
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
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" |
