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

SKU:

TOP59870R

Your Price:

$333.15/CT

Quantity:

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.