Skip to Header
Skip to Navigation
Skip to Main Content
Skip to Footer
Menu Links
Home
About Us
My Account
Contact Us
Blog
Product Help
800.379.7969
Log into Account
Login
Register a New Account
Register
Menu
View your Shopping Cart
cart
Shopping Cart
0
Items -
$0
cart
0
Items
Toggle navigation
Category Links
Bags and Bows
Tissue Paper
Shipping
Bags
Boxes
Gift Wrap
Bows
Gift Cards
Business Envelopes
Return Reply
Specialty
By Size
Check Envelopes
First Class
Tax Filing
by Profession
Medical
Real Estate
Retail Store
Accounting / CPA
Automotive
Hospitality
Finance
Professional Services
Florist
HVAC
Jewelery
Law Office
Photography
Plumbing
Veterinary
Food Service
Cleaning
Flooring
General Contractor
Landscape
Pest Control
Office Supplies
Folders and Covers
Business Checks
Money Handling
One Writes
Paper and Letterhead
Portfolios
Promotional
Stamps
Breakroom
Mailroom
Accessories
Binders
Business Forms
Corporate Gifts
Storage
Your Software
Appointment
Messages
Seals and Labels
Tags
Advertising
Anniversary
Made In America
Custom Stickers
Medical
Holiday
Mailing
Pricing
Service
Specialty
Digital Seals
Tax Forms
W2
Blank Forms
1098-1099
Envelopes
Software
Misc Forms
Pressure Seal
Bulk Tax Form
Legal Forms
Past Year Forms
Home
by Profession
Medical
CMS
UB-04 Hospital Claim Form - 1,000 forms
Zoom in on Image(s)
Add to Wish List
Email a friend
UB-04 Hospital Claim Form - 1,000 forms
Write a Review
Your Price:
$124.85
Retail Price
Retail Price:
$219.99
You Save:
$95.14
(43%)
Questions about this item? Be the first to ask here.
Part Number:
UB04CF
Availability:
We are Sorry item is Out of Stock.
Free Shipping.
Feature:
Printed with special red scannable ink
Feature:
Price is for 1000 forms
Feature:
Page Size is 8 1/2 x 11
Feature:
Meets HIPAA ASC X12N 837-Institutional Transaction Standard
Put me on the Waiting List
product tabs
Description
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
Related Items
Quick View
CMS-1500 Laser Printer Medical Claims Form - 500 forms
$45.62
In Stock.
Free Shipping.
Add to Wish List
Add To Cart
Add to Cart
Quick View
CA Balance Due Envelope 6 x 9, 100 envelopes
$58.12
In Stock.
Free Shipping.
Add to Wish List
Add To Cart
Add to Cart
Quick View
Claim Form Compatible Envelope - Small - 500 envelopes
$64.27
In Stock.
Free Shipping.
Add to Wish List
Add To Cart
Add to Cart
Recently Viewed Items
Turn History Off
[history_item_name]
[ITEMPRICE]
[ITEMPRICE]
Original price
[ITEMSALEPRICE]
Sale
Clear
×
Menu Links
Categories
[ITEMPRICE]