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UB-04 instructions and forms can be downloaded free of charge from the Web site for the Centers for Medicare and Medicaid Services. (CMS) at cms.hhs. The UB04 claim form is used to submit claims for inpatient and outpatient services by A UB04 with field descriptions and instructions is included. ** Claim forms must be mailed flat, with no folding, in 9" x 12" or larger envelopes. ** Put a return address on the envelope. ** Separate the claim form fromUB-04 Claim Form Instructions. FORM LOCATOR NAME. INSTRUCTIONS. 1. Billing Provider Name &. Address. Enter the name and address of the hospital/facility. The UB-04 claim form accommodates the National Provider. Identifier (NPI) and has incorporated other important changes. Sample UB-04 forms for inpatient and Sample UB-04 forms for inpatient and outpatient claims can be found on pages 4 and 5. If you have any questions regarding the UB-04 claim form, please call your