About
Description
Used by hospitals and institutions to file a medical claim with a patient's insurance company
- Meets the requirements of the Centers for Medicare and Medicaid Services (CMS). Printed on carbonless, 20-lb bond, 1-ply paper with red ink.
Specs
| Manufacturer # | |
| Brand Name | TOPS |
| Carbonless | Yes |
| Color (ink) | Red |
| Double Sided | Yes |
| Eco Label Standard | SFI Certified Fiber Sourcing |
| Manufacturer | TOPS BUSINESS FORMS |
| Number of Holes Punched | 0 |
| Number of Parts | 1 |
| Product Line | UB-04 Forms |
| Quantity | 2500 |
Description
Used by hospitals and institutions to file a medical claim with a patient's insurance company
- Meets the requirements of the Centers for Medicare and Medicaid Services (CMS). Printed on carbonless, 20-lb bond, 1-ply paper with red ink.
| Attribute Name | Attribute Value |
|---|
TOPS
by
TOPS
59870R
TOPS UB-04 Forms, 1 Part, White, 8 1/2in x 11in, Box Of 2,500
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