TOPS 59870R 1-part UB-04 Laser-cut Forms
   
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TOPS 59870R 1-part UB-04 Laser-cut Forms

1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton
Item #: TOP59870R


Retail/List price: $237.63
$144.52 for Carton

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Inventory last updated: 10/21/2020 9:00pm EDT
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  • Replaces the UB-92
  • 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
The Manufacturer's Description 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.

MAIN FEATURES

Product TypeClaim Form
Brand NameTOPS
ManufacturerTOPS Products
Product ModelUB-04
Product Name1-part UB-04 Laser-cut Forms
Manufacturer Part Number59870R
Manufacturer Website Addresshttp://www.tops-products.com
Packaged Quantity2500 / Carton

OTHER FEATURES

Number of Parts1
Form Length11"
Form Width8.50"
Environmentally FriendlyYes
Environmental CertificationSFI
Number of Forms per Sheet1
Printed SideFront
Country of OriginUnited States
RecycledNo
Assembly RequiredNo
ColorWhite
Certifications & Standards

American Medical Association

Print ColorRed
Print TechnologyLaser

ADDITIONAL CHARACTERISTICS

UPC code025932598708
Alternate code/substitutionTOP59870R
Moore prefix and stock number
Package Weight
Package Height
Package Length
Package Width
Product Classification CodeEFFA
Country of OriginUS
Ready to AssembleN
RecycledN
UPS-ableY
Recommended substitutions
Old item number
Minority/Women-Owned/Challenged Vendor
Old item number
Non-returnableN
Special order itemN
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