TOPS UB04 Health Care Form Revised HCFA Compliant 59770R
Product details
| Management number | 254499872 | Release Date | 2026/11/07 | List Price | US$7.72 | Model Number | 254499872 | ||
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Revised Format. AMA approved format. The UB-04 is the form hospitals and institutions e to file a medical claim with the patient's insurance company. e TOPS UB-04 forms with confidence. They meet the requirements of the Centers for Medicare and Medicaid Services (CMS) and are available in Laser and Continuo formats. Revised Format. AMA approved format. The UB-04 is the form hospitals and institutions e to file a medical claim with the patient's insurance company. e TOPS UB-04 forms with confidence. They meet the requirements of the Centers for Medicare and Medicaid Services (CMS) and are available in Laser and Continuo formats. . Sold as 2500/Carton.
TOPS UB04 Health Care Form Revised HCFA Compliant 59770R| Standard form & application type | Claim Form |
|---|---|
| Model | UB04 |
| Brand | Tops |
| Sheets | 2500 |
| Piece count | 2500 |
| Color | White |
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