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  Home > NeedInsuranceForms > UB-04 Hospital Insurance Claim Forms >

2-Part Continuous UB-04 Hospital Insurance Claim Forms
New UB-04


 
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Case of 1000 forms $39.95

Availability:: Usually Ships in 1 to 2 Business Days
Product Code: UB042


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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

Accessories for this product...
UB-04 Self-Seal Jumbo Envelopes
Price $8.00

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Jumbo UB Envelope

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