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Health Claim Forms |
| ♦ CMS-1500 (08-05) |
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Hospital Claim Forms |
| ♦ UB-04 |
UB-04
Hospital Insurance Claim Forms
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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. |
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| UB04LC1 |
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100 (package) UB-04 Laser Cut Sheet Hospital Insurance Claim Forms
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Our Price: $4.95 |
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| UB04LC5 |
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500 (package) UB-04 Laser Cut Sheet Hospital Insurance
Claim Forms
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Our Price: $14.95 |
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| UB04LC |
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2500 (case) UB-04 Laser Cut Sheet Hospital Insurance
Claim Forms
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Our Price: $49.95 |
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| UB041 |
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2500 (case) UB-04 1-Part Continuous Hospital Insurance
Claim Forms
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Our Price: $34.95 |
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| UB042 |
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1000 (case) UB-04 2-Part Continuous Hospital Insurance
Claim Forms
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Our Price: $39.95 |
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| UB043 |
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1000 (case) UB-04 3-Part Continuous Hospital Insurance
Claim Forms
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Our Price: $67.95 |
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| UB044 |
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500 (case) UB-04 4-Part Continuous Hospital Insurance
Claim Forms
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Our Price: $40.95 |
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