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ACS is your #1 source for UB-04 Insurance Claim Forms

The UB-04 claim form is the replacement for the UB-92 claim form.

ACS carries a full line of UB-04 Insurance Claim Forms for your facility as well as a full line of Stock Medical Forms on the shelf ready to ship. ACS is also a custom Printer.  We can custom print your - Medical Encounter Forms, Medical History Forms, Medical Release Forms, Medical Billing Forms, Medical Consent Forms, Medical Treatment Forms, Letterhead, Business Cards, Envelopes, Company Checks, you name it we can print it. Always compare our pricing if we are not already better ask us to beat your existing price.

Call us now with your Custom Printing needs. 
1-800-378-1191 or email [email protected]

Uniform Billing (UB-04) Implementation
The UB-04 incorporates the National Provider Identifier (NPI), taxonomy, and additional codes. Many UB-92 data locations have changed on the UB-04 although most of the data usage descriptions and allowable data values have not changed. Bill type processing will change. Starting May 23, 2007, all UB-04s must include a valid NPI.
New / Revised Material
Effective Date: March 1, 2007
Implementation Date: March 1, 2007
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UB-04 Claim Form UB-04 Claim Form

CMS 1450  Continuous 2 Parts

Your Price: $44.00
UB-04 Claim Form UB-04 Claim Form

CMS 1450 Continuous 1 Part

Your Price: $51.00
UB-04 Claim Form UB-04 Claim Form

CMS 1450– Laser Sheet

Your Price: $51.00
UB-04 Claim Form UB-04 Claim Form

CMS 1450  Continuous 4 Parts

Your Price: $55.00
UB-04 Claim Form UB-04 Claim Form

CMS 1450  Continuous 5 Parts

Your Price: $65.00
UB-04 Claim Form UB-04 Claim Form

CMS 1450  Continuous 3 Parts

Your Price: $89.00
   
 
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