Medi-Cal Education & Outreach Provider Relations
Box UB-04 • Options

Click a button below to learn more about the UB-04 claim form.

 

Get a better understanding of how to use the UB-04 Claim Form Web-Based Tutorial.

Introduction

Get step-by-step instructions on
how to complete the UB-04 form.

Compare the differences between the UB-92 Claim Form and the new UB-04 claim form.

Step Instructions
Form Comparison

Practice completing the UB-04 form.

Activity