UB-04 (CMS 1450) Health Hospital Insurance Claim Form, Laser 8-1/2 x 11" 100 Forms Per Pack UB-04 (CMS 1450) Health Insurance Claim Form Laser / Ink-JetFormat 1 Part 24# 8-1/2 x 11 (Letter Size) Accommodates reporting of the National Provider Identifier (NPI) number 100% compliant with the approved update to the HCFA / CMS1450 health claim form