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UB-04 Claim Form Instructions Required (R) fields must be completed on all claims. Conditional (C) fields must be completed if the information applies to the situation or the service provided. NOTE:.

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  1. Open the form in our full-fledged online editing tool by hitting Get form.
  2. Complete the requested boxes that are marked in yellow.
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  4. Use the e-signature solution to add an electronic signature to the form.
  5. Put the date.
  6. Check the whole e-document to ensure that you have not skipped anything.
  7. Hit Done and download your new form.

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