UB04 HCFA 1450

UB04 HCFA 1450 - (Forms/Publications)
Document Information
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Title UB04 HCFA 1450 (A fillable form - 1.5 KB PDF)
Description

Used by hospitals to bill L&I for inpatient/outpatient services. This version includes NPI number.

Detail
Form number F245-367-000
Availability
Online only. See document above to download.
Keywords billing, bills, hospital, inpatient, outpatient
Languages English
Valid dates All dates valid
Contact information Claims for Job Injuries
Web pages For Medical Providers

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