UB-04 PDF Fillable Template for Mac or Windows.

The UB-04 PDF is used by providers submitting UB-04 paper claims. Hospitals, clinics, ambulatory surgery centers and rehabilitation centers can bill multiple third party payers with the form. The screen has the “look and feel” of the original UB-04 designed by the National Uniform Billing Committee (NUBC). Prints text only onto commercially printed Ub 04 claims forms.

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