Cardinal Brands

Tops Ub-04 Hospital Claim Form - 1 Part - 11" X 8.50" Form Size - 2500 / Carton (59870R)

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SKU:
18239332
MPN:
59870r
Availability:
Usually ships the same or next business day. In stock at our CA, IL, MN, NC, NJ, NY, OH, TX warehouses.
Shipping:
Calculated at Checkout
Stock Update:
04/18/2024 10:57:01 AM PST
$158.56
Buy more, get it as low as $
Stock Update:
04/18/2024 10:57:01 AM PST

Description



This item is brand-new, factory sealed.

Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format. Laser Printer Compatible. Form Type Details: UB04; Dated/Undated: Undated; Forms Per Page: 1; Form Size: 8.5 x 11.
  • Printed to Government Printing Office standards.
  • OCR ink for scanning.
  • American Medical Association (AMA) approved format.

    • Form Type Details:UB04
  • Form Type Details:UB04
    • Global Product Type:Insurance Forms
  • Global Product Type:Insurance Forms
    • Global Product Type:Insurance Forms
  • Global Product Type:Insurance Forms
    • Global Product Type:Insurance Forms
  • Global Product Type:Insurance Forms
    • Global Product Type:Insurance Forms
  • Global Product Type:Insurance Forms
    • Dated/Undated:Undated
  • Dated/Undated:Undated
    • Forms Per Page:1
  • Forms Per Page:1
    • Form Size:8.5 x 11
  • Form Size:8.5 x 11
    • Format Indicator:Unbound
  • Format Indicator:Unbound
    • Form Quantity (Total):2,500
  • Form Quantity (Total):2,500
    • Copy Types:One-Part (No Copies)
  • Copy Types:One-Part (No Copies)
    • Paper Color(s):White
  • Paper Color(s):White
    • Color Family:White
  • Color Family:White
    • Printer Compatibility:Laser
  • Printer Compatibility:Laser
    • Paper Stock:20 lb Bond
  • Paper Stock:20 lb Bond
    • Print and Ruling Color(s):Red
  • Print and Ruling Color(s):Red
    • Product Biodegradability in Days:0
  • Product Biodegradability in Days:0
    • Pre-Consumer Recycled Content Percent:0%
  • Pre-Consumer Recycled Content Percent:0%
    • Post-Consumer Recycled Content Percent:0%
  • Post-Consumer Recycled Content Percent:0%
    • Total Recycled Content Percent:0%
  • Total Recycled Content Percent:0%
    • Special Features:Laser Printer Compatible
  • Special Features:Laser Printer Compatible

    • Features

    Certifications & Standards:   

    American Medical Association


     

    Environmental Certification:   
    Sustainable Forestry Initiative (SFI)

     

    Assembly Required:   
    No

     

    Recycled:   
    No

     

    Country of Origin:   
    United States

     

    Specs

    Physical Characteristics
    Product ColorWhite
    General Information
    Brand NameTOPS
    Manufacturer Website Addresshttp://www.tops-products.com
    Marketing InformationUB-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.
    Product TypeClaim Form
    Product Name1-part UB-04 Laser-cut Forms
    ManufacturerTOPS Products
    Manufacturer Part Number59870R
    Product ModelUB-04
    Packaged Quantity2500 / Carton
    Product Information
    Print ColorRed
    Print TechnologyLaser
    Number of Forms per Sheet1
    Number of Parts1
    Printed SideFront
    Form Length11"
    Form Width8.50"

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    Warranty Information

    All Items are Brand New, Factory Sealed and come with a standard warranty. [Read our policies]
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    Tops Ub-04 Hospital Claim Form - 1 Part - 11" X 8.50" Form Size - 2500 / Carton (59870R)
    $158.56