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UB-04 Hospital Claim Form

UB-04 Hospital Claim Form ub04cf

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

  • Size: 8 1/2 x 11
  • 100 forms per unit
  • Meets HIPAA ASC X12N 837-Institutional Transaction Standard