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TOPS UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total – 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.
- Printed to Government Printing Office standards.
- OCR ink for scanning.
- American Medical Association (AMA) approved format.
| Assembly Required | No |
|---|---|
| Product Color | White |
| Post-Consumer Recycled Content Percent | 0% |
| Pre-Consumer Recycled Content Percent | 0% |
| Print Color | Red |
| Print Technology | Laser |
| Print and Ruling Color(s) | Red |
| Printer Compatibility | Laser |
| Product Line | UB-04 Forms |
| Paper Color(s) | White |
| Product Model | UB-04 |
| Product Name | 1-part UB-04 Laser-cut Forms |
| Product Type | Claim Form |
| Recycled | No |
| Refurbished | N |
| Sheet Size | Letter (8-1/2" x 11") |
| Special Features | Laser Printer Compatible |
| Paper Stock | 20 lb Bond |
| Packaging | 2500 |
| Brand Name | Tops |
| Form Width | 8.50" |
| Certifications & Standards | American Medical Association |
| Copy Types | One-Part (No Copies) |
| Country of Origin | United States |
| Dated/Undated | Undated |
| Environmental Certification | SFI |
| Form Length | 11" |
| Form Size | 8.5 x 11 8.5 x 11 |
| Forms Per Page | 1 |
| Packaged Quantity | 2500 / Carton |
| Global Product Type | Insurance Forms |
| Manufacturer | Tops |
| Manufacturer Part Number | 59870R |
| Manufacturer Website Address | |
| Marketing Information | UB-04 laser-cut forms are designed for medical offices to file a claim with the patient's insurance company. Forms are printed to Government Printing Office standards in OCR ink on 20 lb bond. |
| Number of Holes Punched | 0 |
| Number of Parts | 1 |
| Total Recycled Content Percent | 0% |
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