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2018 UB-04 Software, Inc. All rights reserved. 4. Installation -Excel File (Manual Import) – Allows the user to import from their custom Excel file. 75 - General Instructions for Completion of Form CMS-1450 for Billing This form, also known as the UB-04, is a uniform institutional provider bill UB-04 Claim Form Instructions. FORM LOCATOR NAME. INSTRUCTIONS. 1. Billing Provider Name &. Address. Enter the name and address of the hospital/facility. You can access the UB-04 billing information adopted by the NUBC by subscribing to the Official UB-04 Data Specifications Manual. This manual, copyrighted segment and element, the user should verify the corresponding reference. National Uniform Billing Committee. Official UB-04 Data Specifications Manual 2007. The following rules for the UB-04 are excerpts from Medicare instructions, but they are generally universal for billing specially designated facilities. Consult

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