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Tops Ub-04 Hospital Claim Form - 1 Part - 11" X 9.50" Form Size - 2500... 

46 in stock (as of 12/09/2016 06:23 PM)

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Tops Ub-04 Hospital Claim Form - 1 Part - 11" X 9.50" Form Size - 2500 / Carton (59770R)
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Model: 59770R
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$109.87
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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). Forms are printed on 20 lb. Bond paper.

Features

Recycled: No

Recycled Content: 0%

Post-consumer-waste%: 0%

Assembly Required: No

Environmentally Friendly: Yes

Environmental Certification: SFI

Country of Origin: United States

Specification

General Information
ManufacturerTOPS Products
Manufacturer Part Number59770R
Manufacturer Website Addresshttp://www.tops-products.com
Brand NameTOPS
Product ModelUB-04
Product NameUB-04 Hospital Claim Form
Marketing Information

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.

Packaged Quantity2500 / Carton
Product TypeClaim Form
Product Information
Number of Forms per Sheet1
Form Length11"
Form Width9.50"
Number of Parts1
Printed SideFront
Print ColorRed
Print TechnologyDot Matrix
Physical Characteristics
ColorWhite
Title
ProductTitleTOPS UB-04 Hospital Claim Form - 1 Part - 11" x 9.50" Form Size - Red Print Color - 2500 / Carton

Warranty Information

Beach Audio Warranty

This product was added to our catalog on Friday, December 09, 2016.

Code:35-59770r

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