The Medicare Learning Network (MLN) has released a fact sheet on the new UB-04 form. Implementation of the UB-04, which is available in downloadable format, reviews the new UB-04 paper claim form which is only accepted from institutional providers excluded from the mandatory electronic claims submission. It includes background information, the transition period and a crosswalk.

To view, download or print, select the title of the fact sheet from www.cms.hhs.gov/MLNProducts/MPUB/list.asp on the MLN Publications web page.