Medical Forms, Health Insurance Claim Forms, CMS1500, UB92, Hospital Claim Forms

Hospital Claim Forms


The UB-04 uniform billing form is the standard claim form that any institutional provider can use for the billing of medical and mental health claims. It's printed with red ink on white standard paper. Although developed by the Centers for Medicare and Medicaid (CMS), the form has become the standard form used by all insurance carriers.

Who Can Bill Claims Use the UB-04? Any institutional provider can use the UB-04 for billing


  • Community mental health centers

  • Comprehensive outpatient rehabilitation facilities

  • Critical access hospitals

  • End-stage renal disease facilities

  • Federally qualified health centers

  • Histocompatibility laboratories

  • Home health agencies

  • Hospices

  • Hospitals

  • Indian Health Services facilities

  • Organ procurement organizations

  • Outpatient physical therapy services

  • Occupational therapy services

  • Speech pathology services

  • Religious non-medical health-care institutions

  • Rural health clinics

  • Skilled nursing facilities


The UB04 Hospital Claim Form is available in the following formats: 


View Sample
PDF
Laser Hospital Claim Forms - UB-04 Format

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