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Insurance Claim Forms

Tops - TOP59870R - UB04 Hospital Insurance Claim Form

R 7,741

or 4 x payments of R1,935.25 with Payflex

Payflex

Availability: Currently in Stock

Delivery: 10-20 working days

Tops - TOP59870R - UB04 Hospital Insurance Claim Form
- 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
Country USA
Brand Tops
Manufacturer TOPS Products
Binding Office Product
ItemPartNumber TOP59870R -SPR
Model Tops 59870R
UPCs 823019819933
EANs 0641438557737
ReleaseDate 0000-00-00