UB-04 Forms

Want to see how your information populates on the UB04? Preview your UB04 Forms to confirm the accuracy of practice settings and information before submitting a Bill.

Step 1. On the navigation bar, click ‘Settings’, then click the name of the Billing Provider you want to view or edit

This will navigate directly to the Billing Provider Settings.

Step 2. Click ‘Preview UB04 Form’

Step 3. From each drop-down list, select the ‘Attending Provider’, ‘Operating Provider’, ‘Rendering Provider’, ‘Other Operating Provider, and ‘Referring Provider’

The information selected will be used to populate the UB04 Form preview using sample bill information.

Step 4. Click the ‘Preview UB04’ button

This downloads a sample claim form in PDF format. Take a look and make sure your information is correct.

All set! Happy billing!