UB04 HCFA 1450

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

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

Form number F245-367-000
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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