UB 04 Form Filler 15© - the 2015 update to the UB 04 software, for the ICD-10 codes     email

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UB 04 Form Filler 15 presents you with a series of fields on your screen corresponding to each of the boxes on the UB 04 claim form. Each location includes a prompt informing you of the appropriate content. You just type in the data and hit the tab key to move to the next field. When complete, save the form data and print it onto a blank UB 04 in your printer. Each form can be individually saved and used again quickly by just changing dates of services, dollar amounts, etc. The program requires and Microsoft Word. It works on PCs and Macs, all Windows and Mac operating systems.


The UB04 Form (also known as the CMS 1450) is changing again. Not a new form this time, but there are major changes to the way the current form is to be completed. The changes are the result of the shift to the new International Classification of Diseases ICD-10 codes. As we understand it, the required changes are to be implemented October 1, 2015.

As a result of these changes, most current software designed to complete the UB 04 does not allow for entry of longer, revised codes or correct spacing into numerous fields on the form, including fields 33-36, 41-49, 54-57, 67-74,78 and 79. As a result, we have been revising our UB 04 Form Filler software. We have worked closely with one of a our clients, a major Blue Cross, testing our revisions to the software to ensure that all revisions are correct. The updated program is now complete and available.


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This site was last updated 1/30/17

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