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UB-04 Hospital Claim Form for Dot-Matrix Printers
UB-04 Hospital Claim Form for Dot-Matrix Printers

UB-04 Hospital Claim Form for Dot-Matrix Printers

Price:
As low as
$57.99
2,500/Box
57.99Easily file a medical claim with a patient's insurance carrierFile a hard copy of each claim with patient records in case you need to resubmit a claimAvailable in one, two, three and four-part formsUB-04 Hospital Claim Form for Dot-Matrix Printershttp://s7d5.scene7.com/is/image/Staples/s0200809_sc7?$std$http://s7d5.scene7.com/is/image/Staples/s0200809_sc7?$thb$http://s7d5.scene7.com/is/image/Staples/s0200809/UB-04-Hospital-Claim-Form-for-Dot-Matrix-Printers/product_SS1034853UB-04 Hospital Claim Form for Dot-Matrix Printers0.00 57.99Easily file a medical claim with a patient's insurance carrierFile a hard copy of each claim with patient records in case you need to resubmit a claim1-Part formsUB-04 Hospital Claim Form for Dot-Matrix Printers, 1-Parthttp://s7d5.scene7.com/is/image/Staples/s0200809_sc7?$std$http://s7d5.scene7.com/is/image/Staples/s0200809_sc7?$thb$http://s7d5.scene7.com/is/image/Staples/s0200809/UB-04-Hospital-Claim-Form-for-Dot-Matrix-Printers-1-Part/product_683688UB-04 Hospital Claim Form for Dot-Matrix Printers, 1-Part0.00 62.99Easily file a medical claim with a patient's insurance carrierFile a hard copy of each claim with patient records in case you need to resubmit a claim2-Part formsUB-04 Hospital Claim Form for Dot-Matrix Printers, 2-Parthttp://s7d5.scene7.com/is/image/Staples/s0200809_sc7?$std$http://s7d5.scene7.com/is/image/Staples/s0200809_sc7?$thb$http://s7d5.scene7.com/is/

Printed with red ink on white carbonless 20-lb. paper for trouble-free use in your printer.

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.

  • 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
  • Available in one, two, three and four-part forms
  • Continuous forms, compatible with Dot-Matrix printers

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