Click to enlargeUB-04 Hospital Claim Forms and Envelopes

The UB-04 claim form is redesigned to accommodate reporting of the National Provider Identifier (NPI) number. The NPI number, a requirement of the HIPAA legislation, must be used by all HIPAA covered entities.

Our UB-04 hospital claims forms are available in numerous formats and conform to all the latest CMS health insurance claim forms printing standards.

We list only the most popular forms on our website, but we have every version available. If you don't see the form you need, please call (800) MED-SHOP.


NOTE: UB-04 claim forms are used by hospitals to bill inpatient facility charges. For all other services use the CMS1500 claim form.



UB-04 Laser Sheets
UB-04 Laser Sheets

UB-04 Computer Forms 1-Part
UB-04 Computer Forms 1-Part

UB-04 Computer Forms 2-Part
UB-04 Computer Forms 2-Part

UB-04 Computer Forms 3-Part
UB-04 Computer Forms 3-Part

UB-04 Jumbo Claim Envelopes
UB-04 Jumbo Claim Envelopes


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