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TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2″ X 11″, 2500/Carton (59770R Online

Name: TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2" X 11", 2500/Carton (59770R Online
SKU: SKU890389
Price: 98.00 USD
Availability: InStock

$98.00

The UB-04 is the form hospitals and institutions use to file a medical claim with the patient’s insurance companyRevised…

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SKU: SKU890389 Categories: Forms, Medical Forms, Paper Tag: TOPS

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The UB-04 is the form hospitals and institutions use to file a medical claim with the patient’s insurance company

Revised Format
AMA approved format
Use TOPS UB-04 forms with confidence
They meet the requirements of the Centers for Medicare and Medicaid Services (CMS) and are available in Laser and Continuous formats
Made in the USA

Specifications table
Attribute name	Attribute value
Length in Inches	2500
Number of Parts The physical dimensions of the form.	8 1/2″ x 11″
Width in Inches Items of a particular grouping, as merchandised and labeled by a manufacturer	UB04 Health Care Form
Medical Form Type Actual manufacturer name for the color of the product.	White
Print Type	Continuous