UB-04 Forms (CMS-1450 Forms)

The UB-04 form, also known as CMS-1450 form, is the uniform bill for institutional healthcare providers. It replaced the UB-92 claim form on May 23rd, 2007. 

The UB04 form data set accommodates the National Provider Identifier (NPI) and other changes.

The blank UB-04 claim forms are difficult to complete without instructions the Uniform Claim Editor, the best UB 04 form reference for providers.

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

5000 count (2 boxes)