Featuring the new fillable UB04 PDF SmartForm. Only $49.00 per form. Stop filling out your UB04 claim forms by hand! Fill out and submit the new UB04 medical claim form using our UB04 PDF SmartForm and the free Adobe Reader 9.
The UB04 SmartForm allows you to fill in, print, save, secure, fax and email institutional medical claims. Print only the form field data to your pre-printed, official red UB04 forms. The claim data can also be saved or exported in a variety of formats including pdf, xml, and xfdf.