UB-04 Form Laser – CMS-1450 Institutional Health Hospital Insurance Claim Form, 8-1/2" x 11" - 2,500 Sheets
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Form Size: 8-1/2 x 11"
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Color: White, imprinted with Red Inkt
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Paper Weight: 20#
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Parts: 1
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Qty Per Case: 2500 Sheets
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Cartons Per Pallet: 80
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Printer Compatibility: Laser & Inkjet
Order the UB-04 claim form (CMS-1450) in laser format, the standard institutional billing form required by Medicare, Medicaid, and commercial insurance carriers for hospitals, skilled nursing facilities, home health agencies, and outpatient service providers.
Designed for laser & Inkjet printer compatibility, this UB-04 laser form ensures clean, accurate, scanner-ready output for faster claims processing and fewer rejections.
Features & Benefits
✓ UB-04 / CMS-1450 approved format — fully compliant with NUBC (National Uniform Billing Committee) requirements
✓ Replaces UB-92 — the current mandatory standard for institutional paper claims
✓ Laser & Inkjet printer compatible — smooth, jam-free performance
✓ 8-1/2" x 11" standard letter size — compatible with all standard filing and billing software
✓ White, 1-part — single-sheet cut form
✓ In stock & ready to ship — with free fast shipping on every order
✓ Made in the USA – Manufactured domestically for consistent, high-quality results you can trust
Ideal for
hospital billing departments, medical billing companies, skilled nursing facilities, home health agencies, and outpatient clinics submitting institutional claims on paper.
