What is a CMS 1500 or UB-04?
CMS 1500 is government claim form for Medicare and Medicaid Services
compliant when using strict printing standards that govern the layout,
paper, and ink. Each must have accurate content and conform to the
Health Insurance Portability And Accountability Act (HIPPA). The UB-04
is the health insurance claim form for use by hospitals and
institutions. It is designed for hospitals to file a medical claim with
a patient's insurance carrier; So you can be confident our forms are the
most up-to-date and in full compliance with the law.
Medical & Dental Insurance Forms & Envelopes
Click Below to View Forms
CMS 1500
- white with red print
UB-04 -
white with red print
ADA 2012 -
white with black print
Quantity Carton Discounts Available1, 2-5, 6-10, 11-15, 16-20,
21-25, 26-30, 31-35, 36-40
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Forms
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CMS 1500
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UB 04
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ADA 2012
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Medical & Dental Insurance Envelopes
All envelopes are security lined
Envelopes work exclusively with these forms offered on this page
Quantity Carton Discounts Available1, 2-5, 6-10, 11-15, 16-20,
21-25, 26-30, 31-35, 36-40
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UB04 - L Window
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1500 - L Window
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1500 - R Window
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1500 - R Window 1st class
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Dental 2003
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CMS 1500 Window,
Dental 2000
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