TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton
Description
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.
Specifications
UNSPSC Code
14111804
Weight
26lb
Height
8.5in
Width
11in
Length
11.5in
Catalog Page Number
32767
Assembly Required
No
Brand
TOPS
Brand Name
TOPS
Category
Claim Forms
Certifications & Standards
American Medical Association
Country of Origin
United States
Environmental Certification
Sustainable Forestry Initiative (SFI)
Form Length
11"
Form Width
8.50"
Manufacturer
TOPS Products
Manufacturer Part Number
59870R
Manufacturer Website Address
http://www.tops-products.com
Number of Forms per Sheet
1
Number of Parts
1
Packaged Quantity
2500 / Carton
Print Color
Red
Print Technology
Laser
Printed Side
Front
Product Color
White
Product Model
UB-04
Product Name
1-part UB-04 Laser-cut Forms
Product Type
Claim Form
Recycled
No
Starting from
$333.15
/ CT
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