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NUBC National Uniform Billing Committee LIC9213257 QUAL FIRST THE CERTIFICATIONS ON THE REVERSE APPLY TO THIS BILL AND ARE MADE A PART HEREOF. Green Required/Preferred Black Situational/Required if Applicable/Reserved 80 REMARKS H Q SAMPLE OUTPATIENT UB-04 FORM. New UB-04 Form Instructions The Office of Management and Budget OMB and the National Uniform Billing Committee NUBC previously approved the UB-04 claim...
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