SKU: TOP59870R
UPC: 025932598708
Available
TOPS Products
Billing Forms, 20 lb., 8-1/2x11 , 2500/CT, White
$343.14
/ CT
1 Part - 11 x 8.50 Form Size - White - Red Print Color - 2500 / Carton
Shipping Available
Quality Guaranteed
Easy Returns
Features
- 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
- Replaces the UB-92
| Assembly Required | No |
|---|---|
| Brand Name | TOPS |
| Certifications & Standards | American Medical Association |
| Color Family | White |
| Country of Origin | United States |
| Environmental Certification | Sustainable Forestry Initiative (SFI) |
| Manufacturer | TOPS Products |
| Manufacturer Part Number | 59870R |
| Manufacturer Website Address | http://www.tops-products.com |
| Marketing Information | 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. |
| 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 |
Shipping Information
Weight
26.0000 lbs
Dimensions (L x W x H)
11.5000 x 11.0000 x 8.5000 in
Returns Policy
Returns are subject to our standard return policy. Please contact customer service for details.
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