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 the Uniform Billing Editor, the best UB 04 form reference for providers.

All UB04 Forms ship via FREE Ground Shipping (delivery in 2-5 business days).