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UB04CF - UB-04 Hospital Claim Form

UB04CF - UB-04 Hospital Claim Form

UB04CF
Bulk Pricing:
Buy in bulk and save

Bulk discount rates

Below are the available bulk discount rates for each individual item when you purchase a certain amount

  • Buy 2 - 499 and pay only $0.1320 each
  • Buy 500 - 999 and pay only $0.1320 each
  • Buy 1000 - 2499 and pay only $0.0960 each
  • Buy 2500 - 4999 and pay only $0.0590 each
  • Buy 5000 - 9999 and pay only $0.0570 each
  • Buy 10000 - 200000 and pay only $0.0540 each

Price per item:

$0.13

Total:

$ 500
Qty: Order a minimum of 500 and in multiples of 500
! Order in multiples of 500

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.