Healthcare Forms
Hospital Claim Form - UB-04 - Laser Printer
UB-04 Claim Form. The UB04 Hospital Claim Form contains a number of improvements and enhancements that include better alignment with the electronic HIPAA ASC X12N 837-Institutional Transaction Standard
The UB04 paper billing form will be able to accommodate the reporting of the National Provider Identifier (NPI) Number. The NPI will be a single provider identifier, replacing the different provider identifiers healthcare systems currently use for each health plan with which you do business. The NPI Identifier, which implements a requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), must be used by all HIPAA covered entities, which are health plans, healthcare clearinghouses, and healthcare providers
Quantity discounts built into pricing. Call office at 1.800.379.7969 for large quantity orders
Size: 8 1/2 x 11
Shipping: Free
