UB-04 (CMS 1450) Health Hospital Insurance Claim Form, Laser 8-1/2 x 11\ 100 Forms Per Pack
- UB-04 (CMS 1450) Health Insurance Claim Form.
- Accommodates reporting of the National Provider Identifier (NPI) number.
- 100% compliant with the approved update to the HCFA / CMS1450 health claim form.