TOPS UB-04 Continuous Billing Form - 2 Part - Carbonless - 11" x 9.50" Form Size - 1000 / Carton

Sku:

TOP59772R

Upc:

025932597725

(0)
$103.35 / CT
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UB-04 continuous forms are designed for hospitals 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). Continuous forms are printed on 20 lb. bond paper.

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