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    Tops 59870R UB04 Hospital Insurance Claim Form, 8-1/2 x 11, 2,500 Forms

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    UB-04 laser-cut forms are designed for medical offices 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.

    Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format. Global Product Type - Forms-Insurance Form Size - 8 1/2 x 11 Forms Per Page - 1 Form Quantity - 2500 Layout - One Form per Sheet Printer Compatibility - Laser Paper Stock - 20-lb. Paper Color(s) - Red Paper Color(s) - White Print and Ruling Color(s) - Red Pre-Consumer Recycled Content Percent - 0% Post-Consumer Recycled Content Percent - 0% Total Recycled Content Percent - 0% Special Features - For Laser Printers

    Warranty & Returns

    Warranty, Returns, And Additional Information

    Return Policies

      We want to ensure your holiday shopping this year is hassle-free. That’s why we’re automatically extending our return policies on almost every product! For purchases placed between November 1st, 2025 and December 31, 2025 you will have until January 31, 2026 to return your product.

    • Return for refund until: January 31, 2026
    • Return for replacement until: January 31, 2026
    • This item is covered by Newegg.com's Extended Holiday Return Policy.
    • Read full return policy for details.
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