UB-04 (CMS-1450) & UB-92 (HCFA-1450) Forms

The UB-04 (CMS-1450) form is used for submitting hospital, in-patient, some ADHC, transportation and related charges to Medicare and most insurance companies. This form is printed on White paper with a special Red ink required for optical scanning.  It is available in Laser / Ink Jet sheets and 1 to 5 part continuous tractor feed formats. We also have special UB-04 (CMS-1450) envelopes. (Physician services are billed with the HCFA/CMS-1500 Form).

New UB-04 Forms available now!

There is a new version of the HCFA / CMS-1450 known as the UB-04 Form. This replaced the old UB-92 beginning in March 2007 with a phased in transition. The final switchover was scheduled on May 23, 2007 but as with many things in the healthcare and government approval process it has taken a little longer. We have the new UB-04 available in all our warehouses.

With very few exceptions everyone should be using the new forms now. For those that need "old forms" for specific uses We still make the old UB-92 version HCFA-1450 form in limited quantities. They are not listed or illustrated below to avoid confusion. For the few people still needing them just give us a call and we can help!


Pricing is similar to the new CMS-1500 forms on our site. There are a lot of changes on this form in addition to just adding the NPI fields. If you would like a sample faxed or mailed to you just give us a call. And when you are ready to test your software with the new UB-04 we have then ready to ship.

Pricing and Buying UB Forms
We know there are many considerations when deciding where to buy your forms. You have local suppliers, mail order catalog companies, buying cooperatives, and of course companies advertising on the Internet. If you want the lowest   total cost (forms + shipping + service) you have come to the right place. But we offer more than just the lowest total cost. See the Top 10 reasons to buy from Rx Data Systems for what makes us your best choice.

Prices are shown for a single box of forms. Save even more by buying more! 

Confused by all the choices we have? Just call us and we'll make it easy!

Don't forget UB-04 (CMS-1450) envelopes!.

Save even more by using our Print & Fax Order Form.

Call (800) 828-1355 to order or with any question.

Large quantity and contract pricing is also available.

All forms listed are printed to NUBC / Medicare standards with special OCR Red Ink on the front. The backs of the forms are printed in Black Ink (as required) with the Government / CHAMPUS specified information. All Multiple Part forms are carbonless and all pages on the UB-04 Multi-Part Forms are on White Paper.

Shipping

Prices do not include shipping. We ship from 16 warehouses around the U S and will calculate the lowest shipping costs when you place your order. Shipping averages $9 - 13 / box based on the weight and where you are in relation to our warehouses.  Most of the US is 1-2 days by ground via UPS/FedEx from one of our 16 shipping locations. Your total cost is lower with us because our forms and our shipping together are less and we have no handling fees and still provide live customer service!   Figuring the lowest shipping takes us more time but we save you dollars per box by only charging you for our actual discounted cost of shipping.

Forms average 28 pounds per box, so shipping can be costly. By shipping from 16 locations and only charging real shipping costs we reduce your total cost and you get your forms fast. Not all companies operate this way (each to their own) but we think you should know what your total cost covers. Note that those companies who say shipping is "FREE" just include the cost of shipping in their higher prices. If you want to see what shipping can cost just go to www.ups.com and see how much it costs to ship a 28 pound box from your home to your office. Because we ship such a large volume we get a discounted rate and we pass that on to our customers who make it possible. But you know UPS does not deliver things for Free no matter how much business you give them!

A LOT of Internet Orders have shipping priced at an "average" rate and everyone pays the same. We don't think we have "average" customers. For most customers shipping is less than $11/bx. For a few who live in remote areas of the 48 contiguous states (and you generally know if you do) it just costs a dollar or two more. It is not fair to most customers to "average" higher shipping costs in so they pay more. We give everyone the lowest shipping rate we can on every order. For us shipping is not a profit center. We know it is expensive and we do our best to minimize those costs for our customers on an individual basis. For those in Alaska and Hawaii we have a special shipping plan for you to reduce costs as well! We prefer to be upfront about what part of your order is shipping and what part is products. Some of our competitors do it different to make you "think" you are not paying or paying less for shipping. We ship more forms from more locations than anyone else in the country. And we do it fast and with live customer service!

Save even more by using our Print & Fax Order Form.

We have many other medical billing forms and products available including HCFA/CMS-1500 forms with blown on labels. We stock the latest forms as well as older forms in laser and continuous. We have all the  UB-04 Envelopes and HCFA-1500 Envelopes. Of course we have all the ADA Forms, Billing Statements, Coding Books,  statement mailers, HIPAA compliance forms, alphabetic and year labels, and more. All at the lowest total prices in the industry.

Call (800) 828-1355 to order or with any questions. 

We welcome Orders by Check or Money Order        Concerned about ordering from an Internet company?
Want to know more about our shipping? 

Send mail to "masteroftheweb" at rxds.com with questions or comments about this web site.
Copyright © 1999-2010 Rx Data Systems, Inc.
Last modified: January 1, 2010