Tops
Tops 59870R Forms & Record Keeping Ub-04 Hospital Claim Form TOP59870R 818237890116

Part Number: 59870R
Catalog Page: 979 all products on page
Unit: CT
Condition: New
In Stock: 14  
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Product Specifications



TOPS UB-04 Hospital Claim Form - 1 Part - 11" x 8.50" Form Size - Red Print Color - 2500 / Carton 59870R TOP59870R pg.979.

UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5

Manufacturer Part Number: 59870R



CPN:UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5
MANUFACTURER NAME: Tops
MANUFACTURER PART NUMBER: 59870R
UPC EAN CODE: 818237890116
LANGUAGE: EN
MARKET:US

General 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.

ManufacturerTOPS Products
Manufacturer Part Number59870R
Manufacturer Website Addresshttp://www.tops-products.com
Brand NameTOPS
Product ModelUB-04
Product Name1-part UB-04 Laser-cut Forms
Packaged Quantity2500 / Carton
Product TypeClaim Form
  Product UPC818237890116
Product Information:
Form Length11"
Form Width8.50"
Number of Parts1
Printed SideFront
Print ColorRed
Physical Characteristics:
Product ColorWhite
Miscellaneous:
RecycledNo
Country of OriginUnited States
Environmental CertificationSustainable Forestry Initiative (SFI)

Date Inserted: Tuesday August 20, 2013

This product was last updated on Tuesday November 5, 2024

All products are brand new and factory sealed unless otherwise stated.
 *** Disclaimer- Information is supplied by the Manufacturer. The image, including color, may differ from actual product appearance. CompSource, Inc. is not responsible for data. ***

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Shipping / Returns

Shipping

Ground = 44
(EST. Arrival Date between Fri.Nov.8 - Wed.Nov.13)

Two Day Air = 114
(EST. Arrival Date on Fri.Nov.8)

Standard One Day = 167
(EST. Arrival Date on Thu.Nov.7 after 3PM)

Priority = 187
(EST. arrival Date on Thu.Nov.7 in the AM)

U.S Mail Priority (AA,AE,AP only) = 113.33

FedEx International Economy (Canada only) = 174

Shipping dates are best estimates based on product location and may vary with holidays.

If product requires trucking, additional fees may apply.

* Some destinations are subject to Applicable State/Duty Taxes

Returns

CompSource realizes that every product may have different return guidelines. Please see the policy below regarding this item.

This Product Has Limited Exchange Privileges.

Limited returns within 30 days of purchase permitted on this product.

For support on this product, please contact Tops. 800-621-1291 www.tops-products.com


Tops Company's Information

Tops  
Click Tops for all products

Toll Free #: 800-621-1291

Site:  www.tops-products.com

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