UB04 HCFA 1450
 

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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
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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