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Ink, Toner & Ribbon 
» Office Supplies » General Office Supplies » Forms » Claim Forms

Billing Forms,Continuos,1-Part,20 lb.,9-1/2"x11",2500/CT

Billing Forms,Continuos,1-Part,20 lb.,9-1/2"x11",2500/CT


MFG Part #:

    59770R

Our Part #:

    TOP59770R

Printer Brand:

    Tops Business Forms
 


InkMart Price:

   $ 180.75

 

     
IN STOCK
Quantity: Add to Cart
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UB-04 continuous forms are designed for hospitals 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.