TOPS UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms

Product Number: TOP59870R
  • Printed to Government Printing Office standards.
  • OCR ink for scanning.
  • American Medical Association (AMA) approved format.
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$226.50
Free Shipping Estimated Delivery  Thu 6/24  Thu 6/24   (3 business days)  
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Product Description

TOPS UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms - 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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Product Specifications

  • Assembly Required
    No
  • Brand Name
    Tops
  • Certifications & Standards
    American Medical Association
  • Color
    White
  • Country of Origin
    United States
  • Environmental Certification
    SFI
  • Environmentally Friendly
    Yes
  • Form Length
    11"
  • Form Quantity
    2500
  • Form Size
    8.5 x 11 8.5 x 11
  • Form Width
    8.50"
  • Forms Per Page
    1
  • Global Product Type
    Forms-Insurance
  • Layout
    One Form per Sheet One Form per Sheet
  • Manufacturer
    Tops
  • Manufacturer Part Number
    59870R
  • Manufacturer Website Address
    www.tops-products.com
  • Number of Holes Punched
    0
  • Number of Parts
    1
  • Packaged Quantity
    2500 / Carton
  • Packaging
    2500
  • Paper Color(s)
    Red White
  • Paper Stock
    20-lb.
  • Post-Consumer Recycled Content Percent
    0%
  • Pre-Consumer Recycled Content Percent
    0%
  • Print Color
    Red
  • Print Technology
    Laser
  • Print and Ruling Color(s)
    Red
  • Printer Compatibility
    Laser
  • Product Line
    UB-04 Forms
  • Product Model
    UB-04
  • Product Name
    1-part UB-04 Laser-cut Forms
  • Product Type
    Claim Form
  • Recycled
    No
  • Refurbished
    N
  • Sheet Size
    Letter (8-1/2" x 11")
  • Special Features
    For Laser Printers
  • Total Recycled Content Percent
    0%

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