TOPS UB04 Hospital Insurance Claim Form, 8.5 x 11, 1/Page, 2,500 Forms - 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.
Tops Ub04 Hospital Insurance Claim Form, 8.5 X 11, 1/Page, 2,500 Forms
- Printed to Government Printing Office standards.
- OCR ink for scanning.
- American Medical Association (AMA) approved format.
This product is shipped from our supplier's warehouse in Colombus, WI, United States
This product is brand new and includes the manufacturer's warranty, so you can buy with confidence.
A 25% handling charge is levied against all authorized returns except those due to our error. Unauthorized returns are subject to a 40% handling charge. Damages & defects must be reported to us within 14 days.
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