Please ensure Javascript is enabled for purposes of website accessibility TOPS UB04 Hospital Insurance Claim Form, 8.5 x 11, 1/Page, 2,500 Forms (59870R) | OfficeCrave.com
Back to Shop
Shop By Category
TOPS UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total (59870R)

TOPS UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total (59870R)

$192.77

- +

TOPS UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total (59870R)

TOPS UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total (59870R)TOPS UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total (59870R)
$7.75 OFF
TOPS UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total (59870R)
Bulk Discounts
Bulk
Discounts
1-2 Day Shipping
1-2 Day
Shipping
Easy Returns
Easy
Returns
Made in USA
Made
in USA
AutoShip Eligible
AutoShip
Eligible
Google Trusted Store
Google
Trusted
Secure Checkout
Secure
Checkout
Satisfaction Guaranteed
Satisfaction
Guaranteed

Product Details

View More +

Stock-Up & Save Event

$192.77 $200.52 Case of 2500 ($0.08/Each)

- +

Estimated Delivery Date: 06/06/2026

Crave & Save AutoShip
$192.77
$200.52
Save 5%
Choose Your Frequency:
- +

Estimated Delivery Date: 06/06/2026

Request a Quote

Desired Quantity (Minimum Bulk Quantity Quote: 26)
Additional shipping charges may apply to quotes that exceed standard weight and dimensions.
In Stock
SKU: TOP59870R
Bulk Discounts
Bulk
Discounts
1-2 Day Shipping
1-2 Day
Shipping
Easy Returns
Easy
Returns
Made in USA
Made
in USA
AutoShip Eligible
AutoShip
Eligible
Google Trusted Store
Google
Trusted
Secure Checkout
Secure
Checkout
Satisfaction Guaranteed
Satisfaction
Guaranteed

Product Details

  • Printed to Government Printing Office standards.

  • OCR ink for scanning.

  • American Medical Association (AMA) approved format.

  • Shop TOPS Products

Product Description

Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format. Laser Printer Compatible. Form Type Details: UB04; Dated/Undated: Undated; Forms Per Page: 1; Form Size: 8.5 x 11.

Product Specs

Manufacturer

MPN

TOP59870R

Model#

59870R

Alternate Product Number

811021

UPC Code

025932598708

UNSPSC Code

1

Copy Types

One-Part (No Copies)

Dated/Undated

Undated

Form Size

8.5 x 11

Forms Per Page

1

Global Product Type

Paper Color(s)

White

Paper Stock

20 lb Bond

Post-Consumer Recycled Content Percent

0%

Pre-Consumer Recycled Content Percent

0%

Print and Ruling Color(s)

Red

Printer Compatibility

Laser

Special Features

Laser Printer Compatible

Total Recycled Content Percent

0%

Color Family

White

Form Type Details

UB04

Format Indicator

Unbound

Form Quantity (Total)

2,500

Assembly Required

No assembly is required

Contains Recycled Materials

N

Green Product

N

Unit of Measure

Carton

Item Weight

26

Ships via UPS

Y

Carton Pack Quantity

2500 Each

This item is sold by the

Carton which contains 2500 Each

GTIN Item

025932598708

UPC Retail

025932598708

UPC Carton

50025932598703

Brand

TOPS

Manufacturer Stock No.

59870R

Country of Origin

US

UNSPSC Number

14111806

Q & A (10)

Questions & Answers

Q: How many UB04 forms are included in one box?

1 Answers

How many UB04 forms are included in one box?
08-03-2024

A: Each box contains 2,500 forms.

08-04-2024

Q: Is a template available for these forms?

1 Answers

Is a template available for these forms?
07-11-2024

A: Templates for the UB04 forms can be downloaded from various online sources.

07-12-2024

Q: What type of paper is used for these forms?

1 Answers

What type of paper is used for these forms?
07-09-2024

A: The forms are printed on standard paper suitable for laser printers.

07-10-2024

Q: Can these forms be used for both Medicare and Medicaid billing?

1 Answers

Can these forms be used for both Medicare and Medicaid billing?
06-07-2024

A: Yes, the TOPS UB04 forms are suitable for both Medicare and Medicaid billing.

06-08-2024

Q: Are the forms pre-numbered?

1 Answers

Are the forms pre-numbered?
05-05-2024

A: No, these forms are not pre-numbered.

05-06-2024
Showing 1 to 5 of 10 (2 Pages)

Review

4.67 Out of 5

(6 reviews)
Write a review
5 star66.67%
4 star33.33%
3 star0%
2 star0%
1 star0%



Clorox

Top Trending Products

Officecrave.com is a leading provider of office supplies including technology products, maintenance supplies, furniture and more. Our goal is to provide businesses with the lowest price on the highest-quality items and the TOPS UB04 Hospital Insurance Claim Form, 8.5 x 11, 1/Page, 2,500 Forms (59870R) is no exception.

We work with customers from all industries, including schools, government, medical, accounting, corporate, educational, healthcare, finance, military and private industry.

Everything you see on OfficeCrave.com including the TOPS UB04 Hospital Insurance Claim Form, 8.5 x 11, 1/Page, 2,500 Forms (59870R) are manufactured under ISO 9001 Quality Standards. We also stock a full line of TAA compliant products. Being green is an important part of our business and we are meeting all Green Compliance Standards.

Images
}