TOPS UB-04 Hospital Claim Form

1 Part - 11" x 8.50" Form Size - Red Print Color - 2500 / Carton - View Complete Details

Product Number: TOP59870R

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Product Details

Made in
America
Made in America

This product was manufactured in the United States.

TOPS UB-04 Hospital Claim Form - 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.

  • Printed to Government Printing Office standards.
  • OCR ink for scanning.
  • American Medical Association (AMA) approved format.
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