Who should use UB 04

Who Must Use the UB-04

If you are among the following providers, you must use the UB-04 form:

Adult Family Care Homes
Assisted Living Services
Home Health Services
Hospice
Hospitals
ICF-MR (Intermediate Care Facilities for people with Mental Retardation)
Nursing Facilities
Private Duty Nursing
Private Non-Medical Institutions
Cost Reimbursed Boarding Homes (Case Mix and Non-Case Mix)
Community Residences for People with Mental Illness
Residential Child Care Facilities
Substance Abuse Treatment Facilities
Flat Rate Boarding Homes
Psychiatric Facilities