Tops Ub-04 Forms, 1 Part, White, 8 1/2" X 11", Box Of 2,500($262.89Value)

Description

Used by hospitals and institutions to file a medical claim with a patient's insurance company Meets the requirements of the Centers for Medicare and Medicaid Services (CMS). Printed on carbonless, 20-lb bond, 1-ply paper with red ink. | Tops Ub-04...