Home > NeedInsuranceForms > UB-04 Hospital Insurance Claim Forms >   Laser Cut Sheet UB-04 Hospital Insurance Claim Forms
	Starting at $4.95 Availability: Usually Ships in 24 to 48 Hours Product Code: UB04LC1 Quantity 100 200 500 1000 2500 Price $4.95 $7.95 $14.95 $27.95 $49.95 Shipping $4.95 $10.35 $10.35 $10.35 $15.00   Quantities 1000 or less is ship via Quantity*: 100 Forms [Add $4.95] 200 Forms [Add $7.95] 500 Forms [Add $14.95] 1000 Forms [Add $27.95] 2500 Forms [Add $49.95]

Description   The UB-04 contains a number of improvements and enhancements that include better alignment with the electronic HIPAA ASC X12N 837-Institutional Transaction Standard. The New UB-04 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.   Compatible with: The new UB-04 Form will be will be required starting May 23, 2007 Easily file a medical claim with a patient's insurance carrier File a hard copy of each claim with patient records in case you need to resubmit a claim

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