Full color paper proofs of the UB-04 form are available from:

• New Medical Forms
  Sales & Customer Support
  Email: newmedicalforms@pacbell.net
  Phone: 1-877-256-0027
  Online: www.newmedicalforms.com 

The Official UB-04 Data Specifications manual is available from the National Uniform Billing Committee (NUBC). Cost is $150/year for a printable electronic manual or an electronic version with updates. Order online or download the request form and then send to address below:

American Hospital Association
National Uniform Billing Committee
P.O. Box 92247
Chicago, IL  60675-2247

Chapter 25 UB-04 Instructions

• Click here: http://www.cms.hhs.gov/manuals/downloads/clm104c25.pdf

UB-92 Handbook for Hospital Billing and/or UB-04 Handbook for Hospital Billing:

• Go to: www.aha.org
• Go to Red Banner, half way down the page and look for SERVICES.
• Visit the AHA ONLINE STORE.
• Then use the SEARCH box & type BIRKENSHAW or BILLING

For a copy of this form, visit the National Uniform Claim Committee website : www.nucc.org

More information on EDI is located on the Washington Publishing Company website: www.wpc-edi.com

Please contact us at toll free (866) 447-221 or via email at info@bridgefront.com.