Your Cart is Empty

UB-04 (CMS-1450) Claim Forms, 500 Count

  • These claim forms are for major insurance providers including Medicare.
  • Hospitals, nursing facilities, and other in-patient providers can use these easy UB-04 (CMS1450), HIPAA-compliant forms for insurance company reimbursal. The forms are formatted to standard specifications with red ink and 1-part printing style (OMB-0938-0997).
  • All printed fields will align with the correct boxes when using your templates or billing software with our consistently high-quality forms, manufactured in the USA.
  • Thick, 20 lb paper meets all NUBC standards and feeds through both laser and inkjet printers without jamming.
  • These forms are 100% HIPAA compliant, with all forms printed in the USA by US government certified printers.
  • Institutional providers can use a paper copy of the UB04 claims form for facility and ancillary paper billing by medical and mental health care facilities.


Our UB-04 forms are printed in the USA by US-government authorized printers. These forms are completely compliant with NUBC format and coding requirements. All fields, boxes, and layout consistently line up perfectly for easy printing with billing software – there is no need to change settings. The forms are printed in red ink per standards, and the 1-part forms are laser and inkjet printer compatible.

All forms adhere to strict government standards developed by HIPAA in accordance with the American Hospital Association, CMS centers for Medicare and Medicaid services, NUCC, and NUBC.

The forms are on 20 lb paper which meets all standard requirements for UB-04 forms and allows for easy, jam-free printing through laser and inkjet printers.

Use this compliant, ready-to-go UB-04 forms to get your reimbursement money, fast.

We stand behind our products completely. We understand that buying products online can sometimes be difficult because you cannot physically see what you are buying; however, if our product is not exactly what you are looking for or does not meet your expectations, then we welcome you to send them back anytime for a 100% refund. Click here for more information regarding refunds or returns >

Key Features:

  • 20lb paper
  • HIPAA-compliant
  • UB-04 health insurance claim forms (CMS1450)
  • Quantity: 500

Product Details:

  • Brand: Blue Summit Supplies
  • Part #: BSS-92588-376
  • SKU: BSS-92588-376
  • Barcode: X0029SMLN1
  • Package dimensions: 11.1 x 8.9 x 2.1 inches
  • Package weight: 5.13 lbs