UB-04 (CMS 1450) Health Hospital Insurance Claim Form, Laser 8-1/2 x 11 2500 Per Carton

UB-04 (CMS 1450) Health Hospital Insurance Claim Form, Laser 8-1/2 x 11 2500 Per Carton

Carton of 2500 Sheets of UB-04 (CMS 1450) Health Insurance Claim Forms 1 Part 24# 8-1/2 x 11 (Letter Size) Laser / Ink-JetFormat Printed in RED droput ink 100% compliant with the approved update to the HCFA / CMS1450 health claim form Accommodates reporting of the National Provider Identifier (NPI) number The UB-04, also known as the Form CMS-1450, is the uniform institutional provider hardcopy claim form suitable for use in billing multiple third party payers. Unique to Medicare is that the Administrative Simplification Compliance Act (ASCA) prohibits payment of services or supplies for initial claims that a provider did not bill electronically. The UB-04 is the only hardcopy claim form that the Centers for Medicare & Medicaid Services (CMS) accepts from institutional providers (e.g., hospitals, Skilled Nursing Facilities, Home Health Agencies, etc.) which meet the ASCA exceptions or which have been granted a waiver