Form UB-04 Medicare Advantage Institutional Crossover Cover Sheet - Louisiana

What Is Form UB-04?

This is a legal form that was released by the Louisiana Department of Health - a government authority operating within Louisiana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

• Released on March 18, 2022;
• The latest edition provided by the Louisiana Department of Health;
• Easy to use and ready to print;
• Quick to customize;
• Compatible with most PDF-viewing applications;
• Fill out the form in our online filing application.

Download a printable version of Form UB-04 by clicking the link below or browse more documents and templates provided by the Louisiana Department of Health.