UB-04 Fill & Print

UB04 Fill & Print


$189.99 $169.99
* Licenses (# of Users):


Fill out UB-04 (CMS 1450) forms on your computer & print the data.

To download our UB-04 Fill & Print, please click here.
  • Simple interface with Help boxes for ease of use and learning that act as a tutorial

  • Saveload 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 (MS Excel) and MS Access (MS Access), as well as exportation to MS Excel, MS Access, MS Word (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.