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Tops Business Forms 59870R Tops® Laser UB-04 Claim Forms, 1-Part, 8-1/2" x 11", White, 2500 Forms/Carton image.
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Tops Business Forms 59870R Tops® Laser UB-04 Claim Forms, 1-Part, 8-1/2" x 11", White, 2500 Forms/Carton

Item Number: B859394
Manufacturer Part ID: 59870R
Manufacturer: Tops Business Forms

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Retail: $269.95
Price: $263.20
You Save: $6.75 (2.5%)

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    Tops Business Forms 59870R Tops® Laser UB-04 Claim Forms, 1-Part, 8-1/2" x 11", White, 2500 Forms/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.

    Priced unit of measure: Each not Pack

    Minimum/Multiple for Order: 1

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