UB-04 Paper Claim - OMB 0938-0997
Print UB 04 on Paper ClaimPrinted UB-04

Uniform Bill (UB-04) Health Insurance Paper Claim Form


Meets all Government Printing Office Specifications:
• Commercially Printed on 8.5″ x 11″ paper – 20 # white bond
• Laser cut sheets for use in inkjet or laser printers
• OCR “dropout” red ink for processing on scanner equipment
• Instructions for government/private health programs on back
• Accommodates National Provider Identifier (NPI) reporting
• Form CMS 1450 (UB-04) OMB Approved – No. 0938-0997
Shrink wrapped in packs of 100, 200 or 500 sheets.

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The Uniform Bill (UB-04) is the standard paper claim form used by institutional providers used in billing multiple third party payers.
CMS 1450 (UB-04) OMB Approved – No. 0938-0997. Designed for processing on high-speed OCR scanning equipment.

Additional information


100, 200, 500


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