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TOPS 1-part UB-04 Laser-cut Forms, 1 Part, 11" x 8.50" Form Size, White, Red Print Color, 2500 / Carton
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Product Details
Product Highlights
- 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
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.
Product Specifications
| Dimensions / Specifications | |
|---|---|
| Unit of Measure | CT |
| Item Dimensions | 11.00 in. x 8.50 in. x 11.50 in. (W x H x D) |
| Item Weight | 26.000 lbs |
| Carton Pack Quantity | 2500 EA |
| Carton Pack Dimensions | 9.25 in. x 10.25 in. x 0.00 in. (W x H x D) |
| Carton Pack Weight | 26.000 lbs |
| Pack Quantity | 2500 EA |
| This item is sold by the CT which contains 2500 EA | |
| Shipping Info | |
|---|---|
| Can Ship via UPS? | Yes |
| Can Ship via Air Carrier? | Yes |
| Hazmat restrictions? | No |
| Additional Information | |
|---|---|
| Considered Green (less environmental impact)? | No |
| Made of Some or All Recycled Materials? | No |
| Item Specifications | |
|---|---|
| Manufacturer | TOPS Products |
| Manufacturer Part Number | 59870R |
| Product Model | UB-04 |
| Product Name | 1-part UB-04 Laser-cut Forms |
| Packaged Quantity | 2500 / Carton |
| Product Type | Claim Form |
| Number of Forms per Sheet | 1 |
| Form Length | 11" |
| Form Width | 8.50" |
| Number of Parts | 1 |
| Printed Side | Front |
| Print Color | Red |
| Print Technology | Laser |
| Color Family | White |
| Product Color | White |
| Certifications & Standards | American Medical Association |
| Recycled | No |
| Assembly Required | No |
| Country of Origin | United States |
| Environmental Certification | Sustainable Forestry Initiative (SFI) |
| Manufacturer Info | |
|---|---|
| Brand | TOPS (website) |
| Brand Contact | 800-282-7261 |
| Manufacturer SKU | 59870R |
| Retail GTIN (UPC) | 00025932598708 |
| Country of Origin | US |
| UNSPSC Number | 14111806 |
| Product ID | 9461823 |
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