Product Notes: Ships Standard Ground Only.
Newly Implemented UB04 Form Replaces UB92
These forms are the "new" format. The UB-04 claim form is mandatory for all billing from May 23, 2007.
Get help choosing the right forms for your printer! Click Here for the Guide
| UB-92 Hospital Claim Forms | |||
| * You can increase the quantity of packages before check-out. | |||
| Buy Now | $39.95 | 89208 | UB-04 Laser Sheets (1,000/box) |
| Buy Now | $29.95 | 89201 | UB-04 1-Part Continuous Feed Computer (1,000/box) |
| Buy Now | $59.95 | 89202 | UB-04 2-Part Continuous Feed Computer (1,000/box) |
| Buy Now | $52.95 | 89203 | UB-04 3-Part Continuous Feed Computer (1,000/box) |
| Mailing Envelopes for UB-92 Claim Forms | |||
| Buy Now | $39.95 | 79130 | Standard Claims Envelopes- Gummed (500/Pkg) |
| Buy Now | $49.95 | 79133 | Standard Claims Envelopes- Self Sealing (500/Pkg) |
| Buy Now | $89.95 | 79139 | Jumbo UB-92/UB-04 Claim Envelopes (500/Pkg) |
| Product not available for priority shipping. Standard ground shipping only. | |||
CMS is implementing the new UB-04 claim form on March 1, 2007, but the form will not be mandatory until May 23, 2007. The UB-04 claim form is mandatory for all billing from May 23, 2007. All rebilling of claims should use the UB-04, even though the original claim may have been on the UB-92 claim form.
The new UB-04 claim form is redesigned to accommodate reporting of the National Provider Identifier (NPI) number. The NPI number, a requirement of the HIPAA legislation, must be used by all HIPAA covered entities.
These UB-04 hospital claim forms are available in numerous formats and conform to all the latest CMS (HCFA) health insurance claim forms printing standards. UB-04 claim forms are used by hospitals to bill inpatient facility charges. For all other services use the CMS-1500 claim form.
What is the difference in the available formats? "Computer" forms have tear off sides and produce a duplicate copy. "Laser Sheets" are used with a desk jet or ink jet printer.
