TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2" X 11", 2500/Carton (59770R~#|#~s0320918_sc7
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  • Revised Format
  • AMA approved format
  • Use TOPS UB-04 forms with confidence
MADE IN AMERICA

TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2" X 11", 2500/Carton (59770R

Item #: 890389Model #: 59770R
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$195.39
2500/carton

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    • About this product

    The UB-04 is the form hospitals and institutions use to file a medical claim with the patient's insurance company

    • Revised Format
    • AMA approved format
    • Use TOPS UB-04 forms with confidence
    • They meet the requirements of the Centers for Medicare and Medicaid Services (CMS) and are available in Laser and Continuous formats
    • Made in the USA

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    Product specifications table
    Attributes TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2" X 11", 2500/Carton (59770R ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 1,000 (CMS12LC1) ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250) ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 500 (CMS12LC500) TOPS CMS-1500 Health Insurance Claims, 500/Pack (TOP 50126RV)
    Your product
    TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2" X 11", 2500/Carton (59770R
    Price is $195.39
    Out of Stock
    ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 1,000 (CMS12LC1)
    Price is $85.89
    ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
    Price is $34.09
    ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 500 (CMS12LC500)
    Price is $48.09
    TOPS CMS-1500 Health Insurance Claims, 500/Pack (TOP 50126RV)~#|#~43D41C18-579A-4B95-856C2FF6A9BDA1E7_sc7
    Price is $51.89
    Reviews
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    4.8
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    Delivery Information
    Data not available
    Free delivery by Wed, Nov 05
    Delivery by Wed, Nov 05
    Free delivery by Tue, Nov 11
    Free delivery by Wed, Nov 05
    Available in my store
    No
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    No
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    Medical Form Pack Size
    2500
    1000
    250
    500
    500
    Medical Form Type
    Health Insurance Claims
    Health Insurance Claims
    Health Insurance Claims
    Health Insurance Claims
    Health Insurance Claims
    Length in Inches
    11
    11
    11
    11
    11
    Width in Inches
    8.5
    8.5
    8.5
    8.5
    8.5
    True Color
    White
    White / Red
    White
    White / Red
    White / Red
    Print Type
    Continuous
    Laser
    Laser
    Laser
    Laser
    Number of Parts
    1
    1
    Data not available
    1
    1
    Form Size
    8 1 / 2" x 11"
    Data not available
    8 1 / 2" x 11"
    Data not available
    8 1 / 2" x 11"
    Series or Collection
    UB04 Health Care Form
    Data not available
    CMS-1500
    Data not available
    CMS-1500
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    Add To Cart
    Add To Cart

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