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BMS Super Forms UB04CF UB 04 Hospital Claim Form P2124868BMS-UB04CF https://cdnimages.opentip.com/full/BMS/BMS-UB04CF.jpg Super Forms UB04CF UB 04 Hospital Claim Form 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. 2124868 0.0100lbs 0.00 0.00 0.00
Super Forms
25 2025-05-10 In Stock
customer review - by , November 11, 2023
5/ 5stars
These are just as described, no issues, good quality
customer review - by , October 10, 2023
5/ 5stars
I use these for my business and was able to set it up for my printer quickly and easily.
customer review - by , September 9, 2023
5/ 5stars
Product was exactly as described. Great price, great quality - just what I needed.
customer review - by , August 8, 2023
5/ 5stars
Just what I needed what else can you say. Will order from this store every time
customer review - by , July 7, 2023
5/ 5stars
Arrive on time as I ran out.
customer review - by , July 7, 2023
5/ 5stars
Great product.
customer review - by , July 7, 2023
5/ 5stars
Ordered for filing Medicare claims. Seems to be acceptable.
customer review - by , June 6, 2023
5/ 5stars
Great for billing
customer review - by , June 6, 2023
5/ 5stars
Seems to be fine.
customer review - by , May 5, 2023
5/ 5stars
These forms are good for what I needed. They look good.

Super Forms UB04CF - UB-04 Hospital Claim Form, Price/EA

stars Rating 5 | 38 reviews
Brand Super Forms
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SKU: BMS-UB04CF
Unit Price: $0.05
Promo: $0.05 Save 10% when you spend $99+ on select products Mix More
Min.Order Price: $25.00 for 500 units
Quantity:
In Stock
* This item must be ordered in multiples of 500.
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Product Description

Price is for EA.

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.

warning tips WARNING: This product can expose you to chemicals which are known to the State of California to cause cancer, birth defects, or other reproductive harm. For more information, go to www.p65warnings.ca.gov.

Specifications

Return Policy

Dated products, including tax forms, must be exchanged or returned unopened by December 1.
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Customer Reviews
5 stars
35
4 stars
3
3 stars
0
2 stars
0
1 stars
0
By macy
Date: November 08, 2023
These are just as described, no issues, good quality
Rating: 5 stars [5 of 5 Stars!]
By Adam
Date: October 15, 2023
I use these for my business and was able to set it up for my printer quickly and easily.
Rating: 5 stars [5 of 5 Stars!]
By Margaret K.
Date: September 18, 2023
Product was exactly as described. Great price, great quality - just what I needed.
Rating: 5 stars [5 of 5 Stars!]
By A Customer
Date: August 05, 2023
Just what I needed what else can you say. Will order from this store every time
Rating: 5 stars [5 of 5 Stars!]
By Carol Maggio-King
Date: July 20, 2023
Arrive on time as I ran out.
Rating: 5 stars [5 of 5 Stars!]
By Jeanette Guzman
Date: July 11, 2023
Great product.
Rating: 5 stars [5 of 5 Stars!]
Items 1 - 6 of 38 reviews
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