UB-04 (CMS 1450) Health Hospital Insurance Claim Form, Laser 8-1/2 x 11" 100 Forms Per Pack

$19.86
Availability: Many In Stock
SKU: 8385

CMS-1450 / UB-04 Form 

Next Day Labels  UB04 / CMS 1450 forms are completely compliant with NUBC format and coding requirements:

  • Pack of 100 Sheets 8-1/2 x 11, Letter Size 1 part Laser / Ink-Jet Form
  • All fields, boxes, and Layout consistently to line up 100% with billing software 
  • Printed in the USA by Next Day Labels TM with red OCR ink GPO standards 
  • All forms adhere to strict government standards developed by HIPAA in accordance with American Hospital Association
  • Our 92 Bright White 20# lb paper meets all standard requirements for UB-04 forms and allows for easily feeding through laser or inkjet printers without worrying about jamming


100% Refund

Our clients’ happiness is our priority. We absolutely stand behind our products and will make sure you are completely satisfied. Buying items virtually may be more challenging than buying the physical product in a store, since you cannot see the actual item. We at Next Day Labels understand that. If our product isn’t everything you were hoping for, simply return it to us for a 100% refund.



  • UB-04 (CMS 1450) Health Insurance Claim Form
  • Laser / Ink-JetFormat
  • 1 Part 24# 8-1/2 x 11 (Letter Size)
  • Accommodates reporting of the National Provider Identifier (NPI) number
  • 100% compliant with the approved update to the HCFA / CMS1450 health claim form
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