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TOPS
TOPS 1-part UB-04 Laser-cut Forms
- Item #
- TOP 59870R
- Mfr. part #
- 59870R
- UPC
- 025932598708
Account pricing
This item is priced per account. Email or call and we'll send your price.
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.
- 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
General Information
| Manufacturer | TOPS Products |
|---|---|
| Manufacturer Part Number | 59870R |
| Brand Name | TOPS |
| Product Model | UB-04 |
| Product Name | 1-part UB-04 Laser-cut Forms |
| Packaged Quantity | 2500 / Carton |
| Product Type | Claim Form |
Product Information
| Form Length | 11" |
|---|---|
| Form Width | 8.50" |
| Number of Parts | 1 |
| Printed Side | Front |
| Print Color | Red |
Physical Characteristics
| Product Color | White |
|---|
Miscellaneous
| Recycled | No |
|---|---|
| Country of Origin | United States |
| Environmental Certification | Sustainable Forestry Initiative (SFI) |