Ubo4 2026

1. Click ‘Get Form’ to open the ubo4 in the editor.
2. Begin by entering the Billing Provider Name & Address in the designated fields. This identifies the facility submitting the claim.
3. If applicable, provide a different Pay to Address in field 2.
4. In section 3a, input your facility's unique Patient Control Number, followed by the Medical Record Number in section 3b.
5. For Type of Bill (field 4), enter the four-digit code that corresponds to your facility type and billing classification.
6. Continue filling out patient details including name, address, birth date, and sex in sections 8 through 11.
7. Complete admission details such as Admission Date and Hour (fields 12 and 13) using the specified formats.
8. Finally, review all entries for accuracy before saving or submitting your completed form.

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