UB-04 Hospital Claim Form for Laser Printers
| Price: | $57.992,500/Box |
- Item qualifies for free delivery
- Expected Delivery 3-5 Business Days
- Item qualifies for free delivery to a store near you. (Learn more)
- Delivery Only
- Item: 683689
- Model: UB04LC
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Laser forms are printed with red ink on 20-lb. paper.
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
- Compatible with laser printers
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