TOPS UB-04 Hospital Claim FormClaim Forms
1 Part - 11" x 9.50" Form Size - Red Print Color - 2500 / Carton - View Complete Details
Product Number: TOP59770R
In Stock - Hurry, only 27 left.
Estimated Delivery - 1 business day(s) - Tue 2/21 2 business days - Tue 2/21
Free Shipping - This item qualifies for Free Shipping
Note: Must buy in quantities of 1 starting at 3.
Estimated Delivery - The products will be shipped directly from the Manufacturer and will require additional time for delivery.
You May Also Like
Made in America
This product was manufactured in the United States.
TOPS UB-04 Hospital Claim Form - UB-04 continuous forms are designed for hospitals 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). Continuous forms are printed on 20 lb. bond paper.View Product Specs
Still have a question? Click to ask a Question
ReviewsThere are no Customer Reviews yet.
Help out our customers.
Be the first to write a review.
Question & Answer
No questions have been posted for this product.
Have a question about this product? Please click the button below to get started. Once you have posted your question we will submit it to our community of customers and with our own staff who have recent experience with the same product for their open and honest feedback.Ask a Question