Ub04 ms word form 2026

1. Click ‘Get Form’ to open the UB-04 MS Word form in the editor.
2. Begin by entering the Provider Name, Address, and Telephone Number in the designated fields. Ensure accuracy as this information is crucial for processing claims.
3. Fill in the Patient Control Number, which helps track the patient's account within your system.
4. Select the Type of Bill (TOB) from the provided codes based on the patient's admission type. This is essential for categorizing the claim correctly.
5. Input your Federal Tax Number and ensure that all dates are formatted correctly (CCYYMMDD) when entering the Statement Covers Period.
6. Complete patient details including name, address, birth date, and sex. Each field must be filled accurately to avoid delays.
7. For admission details, enter Admission Date and Hour using valid codes provided in the form instructions.
8. Continue filling out additional required fields such as Diagnosis Codes and Procedure Codes as per your records.

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