TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2" X 11", 2500/Carton (59770R
$195.39
Highlights
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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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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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| 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", Pack of 250 (CMS12LC250) | 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) | Adams CMS-1500 Health Insurance Claims, 100/Pack (CMS1500L1V) |
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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 |  Price is $26.99 |  Price is $85.89 |  Price is $34.09 |  Price is $24.79 | |
| Reviews | |||||
| Delivery Information | Data not available | Delivery by Mon, Dec 22 | Free Next-Day eligible by tomorrow | Next-Day Delivery by tomorrow | Next-Day Delivery by tomorrow |
| Available in my store | No | No | No | No | Yes |
| Medical Form Pack Size | 2500 | 250 | 1000 | 250 | 100 |
| 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 / Red | White | White / Red |
| Form Size | 8 1 / 2" x 11" | Data not available | Data not available | 8 1 / 2" x 11" | 8 1 / 2" x 11" |
| Print Type | Continuous | Laser | Laser | Laser | Data not available |
| Number of Parts | 1 | 1 | 1 | Data not available | 1 |
| Series or Collection | UB04 Health Care Form | Data not available | Data not available | CMS-1500 | CMS-1500 |
| Add To Cart | Add To Cart | Add To Cart | Add To Cart |
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