TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton

Item Number: TOP59870R

Retail Price: ~~333.15~~
Our Price: $241.43 / CT (savings 91.72)

Quantity in Stock: 71

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

Additional Information

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.

General Information

Manufacturer: TOPS Products
Manufacturer Part Number: 59870R
Manufacturer Website Address: https://www.tops-products.com
Brand Name: TOPS
Product Model: UB-04
Product Name: 1-part UB-04 Laser-cut Forms
Marketing Information:

Packaged Quantity: 2500 / Carton
Product Type: Claim Form

Product Information

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

Physical Characteristics

Product Color: White

Miscellaneous

Certifications & Standards:

American Medical Association

Recycled: No
Assembly Required: No
Country of Origin: United States
Environmental Certification: Sustainable Forestry Initiative (SFI)

Assembly Required: No

Prefix & Stock Number: TOP 59870R

About Haskell New York Inc.

Through our MAS GSA® 75 Schedule, Haskell is authorized to sell to government agencies such as Social Security, the Dept. of the Interior and even the Department of Defense. Haskell also supports the AbilityOne® program. AbilityOne® provides employment opportunities to people with major disabilities including the blind, wounded veterans and people living with PTSD.

For three generations, the small family owned business has survived the Great Depression, world war, the emergence of the super-stores and transition to an online world by providing personal service and great products at reasonable prices. Haskell is also a member of the ISG™ (Independent Suppliers Group) and can quote specialty items like apparel and branded promotional items. Call for competitive quotes. Installation services available upon request.

contact information