TOPS™ UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total
Our Price: $388.75 CT
Available on backorder
Description
TOPS™ UB04 Hospital Insurance Claim Form
Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format.
Features:
Printed to Government Printing Office standards.
OCR ink for scanning.
American Medical Association (AMA) approved format.
**SPECIAL ORDER ITEM Please allow 7-14 days for delivery**
Keywords: Claim Form; Claim Forms; Continuous Form; HCFA Claim Form; Health Care Claim Forms; Human Resources; Insurance Forms; Personnel; Personnel Forms; TOPS; UB04; Paperwork; Records; Documents; Pre-Printed; Record-Keeping
Additional information
Weight | 10.250 lbs |
---|---|
Dimensions | 12.000 × 9.250 × 12.000 in |
Brand | |
Manufacturer Part Number |
Only logged in customers who have purchased this product may leave a review.
Related products
-
Adams® Gift Certificates With Envelopes, 8 X 3.4, White/canary, 25/book
0 out of 5Our Price: $36.54 EA Add to cart Quick View -
AT-A-GLANCE® Standard Diary Daily Diary, 2024 Edition, Medium/College Rule, Red Cover, (200) 9.5 x 7.5 Sheets
0 out of 5Our Price: $113.33 EA Add to cart Quick View -
AT-A-GLANCE® Undated Class Record Book, Nine To 10 Week Term: Two-Page Spread (35 Students), 10.88 X 8.25, Black Cover
0 out of 5Our Price: $44.69 EA Add to cart Quick View -
AT-A-GLANCE® Paper Flowers Desk Pad, Floral Artwork, 22 x 17, Black Binding, Clear Corners, 12-Month (Jan to Dec): 2024
0 out of 5Our Price: $40.71 EA Add to cart Quick View
Reviews
There are no reviews yet.