The Centers for Medicare & Medicaid 1500 (CMS-1500) form, formerly known as a Health Care Financing Administration-1500 (HCFA-1500) form, is the paper form used to submit claims for professional services. Physicians and clinical practitioners submit their claims on this form, which is printed in red ink and contains spaces for all the necessary information. Directions for completing the form are printed on the back of each one.

Various forms have been used in the past, and it’s essential that you use the current, or correct edition, when submitting a claim via a paper form.

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CLICK THIS LINK TO DOWNLOAD THE CMS-1500 FORM

The Uniform Bill 04 (UB-04) claim form, also called the CMS-1450 or just plain UB in some circles, is used by facilities for their health insurance billing. Hospitals, rehabilitation centers, ambulatory surgery centers, and clinics must bill their services on the UB-04 form in order to get paid by commercial payers. There are 84 boxes on the UB-04. Required fields on the UB include revenue codes, bill type, and sometimes value codes in addition to the information required in the HCFA. Just as with the HCF/CMS-1500, the directions are printed on the back of the form.

CLICK THIS LINK TO DOWNLOAD THE UB-04 FORM