UB 04 Forms

UB 04 Forms (formerly UB 92 forms)

UB 04 forms are used for institutional medical billing. This includes medical claims produced by hospitals, rehab centers, inpatient psychiatric hospitals, nursing homes and others. The forms were updated by the National Uniform Billing Committee (NUBC) from the prior UB 92 forms. The forms are known as CMS 1450 forms.

Paper claims must be submitted on original, not photocopied, print versions of the UB-04 form. Our forms are official accepted paper forms printed in a special OCR-scannable red ink.

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