UB04 Billing Instructions Guide - Maine
5 = Late Charge. **For further explanation on Type of Bill, please refer to the NUBC UB04 Official Data Specifications Manual. 5Provider’s Federal Tax Identification Number6Date(s) of Service (Enter MMDDYY, example 010106)7Leave Blank8aPatient ID (Required if different than the subscriber/insured ID in Form … ................
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