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Are you trying to get an
inpatient rehab claim paid
but need to submit it on a
UB04 Form?

We can help!!
How to get your insurance
claim paid.



Do you need just a few
UB O4 Forms
We can help!
50 UB 04 forms
$10.00 plus shipping
Call Now! 1-800-490-4299
8AM - 4PM EST

UB04 Form


The UBO4 form has replaced the UB92 forms and is used by hospitals, clinics, drug and alcohol rehab centers, laser surgery centers, and ambulatory surgery centers etc. to bill medical insurance claims to the insurance carriers.

We have many calls from people trying to get payment from the insurance company for a claim for a rehabilitation center. Usually they have placed a loved one in rehab and were required to pay in advance as the rehab facility did not participate with their insurance company. When they called the insurance company they found that they were entitled to reimbursement as they did have out of network coverage. The problem arose when they found that to collect the insurance payment, the claim must be submitted on a UB04 form.

Not knowing where to get such a form or how to fill it out correctly, these people found themselves not able to collect from the insurance company. That's where we can help. Here is more information on how we can get your rehab insurance claim paid for you.


It is very important in getting UB-04 claims paid that they are completed properly. They require different information than the other health care billing form - the CMS 1500 form. They require Rev codes, value codes, and type of bill.

If you need help in completing the UB04 claim forms, you will be interested in our ebook "UBO4 Forms - "How to Complete A UBO4 Form Completely and Correctly, Line By Line, Box By Box."
It walks you through the entire form explaining in easy to understand terms with no fluff exactly what needs to be filled in and what can be left blank. You can get more information at the above link.

If the insurance company requires that the claim be filed on a UB04 form, they will deny payment until the claim is filed correctly on the UB 04 form. Errors with the rev codes, type of bill or value codes will cause the claim to be denied.



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