Fill out UB-04 (CMS 1450) forms on your computer & print the data.
- Simple interface with boxes for ease of use and learning that act as a tutorial
- Save & load claims from your hard drive or network
- Creates templates for speed of completion and to eliminate repetitive entries
- Print onto pre-purchased forms or print the entire form in either color or black & white
- Advanced Printer Alignment that calibrates the form with your printer
- Batch Printing allows multiple claims to print with a single click
- Autofill for repetitive transactions in rows 1 - 2 of Boxes 42 - 49
- Automatic Addition calculates charges automatically
- Administrative Security Login to further protect your claim files and enhance HIPAA Compliance through Privacy and Security
- Enhanced Importation/Exportation allows importation from (MS Excel) and (MS Access), as well as exportation to , , (MS Word), and PDF, allowing entry-less claim creation
- Ideal for Institutional Health Care Claims and Medicare/Medicaid Claims
- One-time purchase fee that includes free Technical Support and Software Updates
UB-04 Fill & Print Software Screenshots
Definition of the UB-04 Form
The primary purpose of this revised form is to align the paper form to the electronic data standards, both the current 004010/004010A1 and the future 005010. In addition, these changes have freed up space on the UB-92 paper form for alternative reporting data. Organizations could begin using the new UB-04 paper format on March 1, 2007 and was mandated effective May 23, 2007. After May 22, 2007, the UB-92 paper claim will not be accepted – even as an adjustment claim.
The standard, uniform bill (UB) for institutional healthcare providers that’s used throughout the U.S. is known as the UB-04, which replaced the UB-92 following a four-year study involving National Uniform Billing Committee (NUBC) members and various public surveys. The UB form is used by hospitals, nursing homes, hospice, home health agencies, and other institutional providers.