Medical Forms, Health Insurance Claim Forms, CMS1500, UB92, Hospital Claim Forms

Hospital Claim Forms: Continuous

Hospital Claim Forms: Continuous

Please note that the new version is now available and will be mandatory as of June 1st, 2007. Note that Reprogramming is necessary. Following is the timeline for acceptance:

June 1st, 2007.:
The UB-92 is discontinued; only the new UB-04 billing form is to be used. All rebilling of claims should use the UB-04 billing form from this date forward, even though earlier submissions may have been on the UB-92.

Format:
Continuous Feed Printed in red OCR (optical character recognition)ink on special bond paper in strict compliance with government printing.


View Sample
PDF
1 Part: New UB-04 Format

View Sample
PDF
2 Part-New UB-04 Format

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