Skip to content
TOPS 1-part UB-04 Laser-cut Forms

TOPS 1-part UB-04 Laser-cut Forms - 2500 / CT - 1 Part - 11 x 8.50 Form Size - White - Red Print Color - 2500 / Carton

by TOPS
Save 15% Save 15%
$333.15
$333.15 - $333.15
$333.15
$282.05
$282.05 - $282.05
$282.05
SKU TOP59870R

2500 / Carton

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.

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
  • Replaces the UB-92