UB-04 Fillable PDF – Uniform Billing Claim Form (CMS-1450)
The UB 04 PDF Form Filler is ideal for completing the standard claim form used by institutional health care providers to bill for services.
Type, Print & Save as PDF
Create unlimited claims/templates
Prints Text Only on Pre-Printed Claim Forms
Install on up to 2 Computers
A perfect solution for providers submitting UB-04 paper claims. Used by hospitals, clinics, ambulatory surgery centers and rehabilitation centers billing insurance companies for services rendered.
- Immediate Download of UB-04 PDF after purchase with Credit Card or PayPal.
- Prints Text Only – Requires the UB o4 Paper Claim to put in the printer.
The UB-04 Billing Claim Form (CMS-1450) is used for facility and ancillary paper billing. Approved by the Centers for Medicare & Medicaid Services (CMS) and the National Uniform Billing Committee (NUBC).