Revised Format. AMA approved format. The UB-04 is the form hospitals and institutions e to file a medical claim with the patient s insurance company. e TOPS UB-04 forms with confidence. They meet the requirements of the Centers for Medicare and Medicaid Services (CMS) and are available in Laser and Continuo formats. Revised Format. AMA approved format. The UB-04 is the form hospitals and institutions e to file a medical claim with the patient s insurance company. e TOPS UB-04 forms with confidence. They meet the requirements of the Centers for Medicare and Medicaid Services (CMS) and are available in Laser and Continuo formats. . Sold as 2500/Carton.