What are the features of the Fillable UB-04 PDF?

Looks Like the UB-04

The Fillable UB-04 PDF has the “look and feel” of the original UB-04. The fillable fields are positioned to match the field placement grid on the standard Uniform Billing claim.

Easy Data Entry

The familiar layout is highlighted in blue and tabbed for fast data entry. Each field includes detailed instructions to help the user avoid common billing errors. The form's automated calculations add up service charges automatically.

Works on both Mac & Windows

This Fillable PDF is designed to work with Adobe Reader software, the free and trusted PDF viewer. It works equally well on Mac and Windows computers. The added security and privacy bonus: You will type each claim on your computer, not online or in the cloud.