Are you using the correct form when submitting your claims?

Are you using the correct form when submitting your claims?  This seems simple, but can be more complex than you think. Here is a breakdown of the type of claims and which form is appropriate:

New HCFA | CMS 1500 (02/12)
New HCFA | CMS 1500 (02/12)

CMS-1500:

This is the red-ink on white paper standard claim form used by physicians and suppliers for claim billing. Any non-institutional provider and supplier can use the CMS-1500 for billing medical claims.

  1. Physician services
  2. Physician assistants
  3. Nurse practitioners
  4. Clinical nurse specialists
  5. Nurse midwives
  6. Certified registered nurse anesthetists
  7. Clinical psychologists
  8. Clinical social workers
  9. Home dialysis supplies and equipment
  10. Ambulance services
  11. Clinical diagnostic laboratory services

UB-04:

Form UB04
Form UB04

This is the red-ink on white paper standard claim form used by institutional providers for claim billing. Any institutional provider can use the UB-04 for billing medical claims.

  1. Community Mental Health Center
  2. Comprehensive Outpatient Rehabilitation Facility
  3. Critical Access Hospital
  4. End-Stage Renal Disease Facility
  5. Federally Qualified Health Center
  6. Histocompatibility Laboratory
  7. Home Health Agency
  8. Hospice
  9. Hospital
  10. Indian Health Services Facility
  11. Organ Procurement Organization
  12. Outpatient Physical Therapy Services
  13. Occupational Therapy Services
  14. Speech Pathology Services
  15. Religious Non-Medical Health Care Institution
  16. Rural Health Clinic
  17. Skilled Nursing Facility