UB-04 Hospital Claim Form for Laser Printers (UB04LC)
Supplies and Accessories
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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