NEW UB-04
 
 
 
 
 
 
 
 
 
 
 
 

 

 

 

 
 

 

 

 

 

 

  Now Shipping  new UB-04 forms (replaces UB-92)

(See below to order)

 

Hear our Audio Welcome!

 

NUBC Announces Approval of UB-04

Following close of public a public comment  period and careful review of comments received,  the National Uniform Billing Committee (NUBC) announces the approval of the UB-04 Billing Claim form as the replacement for the UB-92 at its February 2005 meetingi

(click for picture of UB-04)

What you need to know about the new UB-04

Here are the frequently  asked questions regarding the NEW UB-04 Claim form:

Why is it changing?

The UB-04 contains a number of improvements and enhancements that include better alignment with the electronic HIPAA ASC X 12N 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 used for each health plan with which you do business. The NPI Identifier, which implements a requirement of 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.

What are the timelines for the transition of the new UB-04?

bulletMarch 1, 2007: Health plans, clearinghouses, and other information support vendors must be ready to handle and accept the new UB-04 Billing form.
bulletMarch 1, 2007 - May 23, 2007: Providers can use either the current UB-92 or the New UB-04 Billing form.
bulletMay 23, 2007: The UB-92 is discontinued; only the UB-04 billing form is to be used. All rebilling of claims should use the UB-04 billing form from this date forward, even though earlier submissions may have been on the UB-92.

Will the form name change?

The form will be known as the UB-04

 

  When would you like delivery? * 1-2 or 5 day

RUSH! - 500  UB-04  (replaces UB-92)Laser Forms 

 Rush!  500   UB-04 Forms  (includes  Ship)  (Business days)

 2 Day delivery $49.95
Quantity
 5 Day delivery $34.95
Quantity

 

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Laser UB-04  Hospital Claim form 

Form # UB-04 LC

Quantity

Quantity Per Box:  2500 Sheets

$ 58.95 per box  

FREE Shipping included on above item!!

 

 UB-04-1   1 part Tractor Feed 


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UB-04 (replaces UB-92) Hospital Claim form 1 Part Continuous

Form # UB-04-1

Quantity

Quantity Per Box:  2500 Sheets

$ 58.95 per box  

FREE Shipping included on above item!!

 

 

 UB-04  - 2 part Tractor Feed 

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UB-04 (replaces ub-92)Hospital Claim form 2 Part Continuous

Form # UB-04-2

Quantity
 

Quantity Per Box:  1000 Sets

$ 47.95 per box  

FREE Shipping included on above item!!

 

 UB-04  - 3 part Tractor Feed 

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UB-04 Hospital Claim form 3 Part Continuous

Form # UB-04-3

Quantity

Quantity Per Box:  1000 Sets

$ 74.95 per box  

FREE Shipping included on above item!!

 UB-04  - 4 part Tractor Feed 


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UB-04 Hospital Claim form 4 Part Continuous

Form # UB-04-4

Quantity
 

Quantity Per Box:  500 Sets

$ 49.95 per box  

FREE Shipping included on above item!!

 UB-04  - 5 part Tractor Feed 


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UB-04 Hospital Claim form 5 Part Continuous

Form # UB-04-5

Quantity

Quantity Per Box:  500 Sets

$ 59.95 per box  

FREE Shipping included on above item!!

 


I

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UB-92 Self-Seal Jumbo Hosp FM Jumbo Left (Self-Seal) Window Envelope

(These work with UB-04 Forms)

Form # 1492LL

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Quantity Per Box:  500

$ 81.95 per box  

FREE Shipping included on above item!!

 

 

 

 

 

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