printable ub 92 claim form
UB-92.pdf
Instructions for Completing OWCP-04 Uniform Billing Form For Medical Services Provided Under the FEDERAL EMPLOYEES COMPENSATION ACT.
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UB92 Claim Form
UB92 Claim Form. Facility billing name and address. 2. 3 PATIENT CONTROL NO. 4. TYPE. OF. BILL. 5 FED. TAX NO. 6 STATEMENT COVERS PERIOD. 7 COVD. 8 N-C D. 9
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instructions for completing the ub-92 claim form
Apr 20, 2005 All entries on a UB-92 are made in a field called the Form Locator (FL). All Form Locators (FL) are assigned a number. For example, Form Locator
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