TOPS UB-04 Continuous Hospital Insurance Claim Form, 1 Part, 9.5 x 11 Inches, Removable Margins, 2500 Sheets per Carton, White (59770R)
$67.31
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Description
UB-04 1-part continuous is a form that hospitals use to file a claim with the patient's insurance company.Forms are printed to GPO standards in OCR ink on 20 lb. bond.9.5 x 11 inch size - 2,500 sheets per carton.Replaces UB-92.Meets the requirements of the Centers for Medicare and Medicaid Services (CMS)
