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TOPS

TOPS 1-part UB-04 Laser-cut Forms

  • Product Type : Claim Form
  • Item # :  TOP59870R

Quick Overview

  • Continuous forms are designed for hospitals to file a claim with the patient's insurance company
  • 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
  • Replaces the UB-92

$312.26/Carton

 
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