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Per federal regulations, all Healthcare providers must use the CMS-1500 or UB-04 Form for specific types of billing. The CMS-1500 Form accommodates reporting of the National Provider Identifier which must be used by all HIPAA-covered entities. The UB-04 Form is for use by hospitals filing a medical claim with the patient's insurance carrier.

Printed with OCR "dropout" red ink on 20# paper, per Government Regulations
Available in continuous, laser and snap-apart

National Uniform Claim Committee Approved Timeline for New Forms

As of August 6, 2013

The NUCC has approved a transition timeline for the version 02/12 1500 Health Insurance Claim Form (1500 Claim Form). In June, the NUCC announced the approval of the updated 1500 Claim Form that accommodates reporting needs for ICD-10 and aligns with requirements in the Accredited Standards Committee X12 (ASC X12) Health Care Claim: Professional (837P) Version 5010 Technical Report Type 3.

The NUCC approved the following transition timeline at its in-person meeting in Chicago on August 1, 2013.

January 6, 2014: Payers begin receiving and processing paper claims submitted on the revised 1500 Claim Form (version 02/12).
January 6 through March 31, 2014: Dual use period during which payers continue to receive and process paper claims submitted on the old 1500 Claim Form (version 08/05).
April 1, 2014: Payers receive and process paper claims submitted only on the revised 1500 Claim Form (version 02/12).

This timeline aligns with Medicare's transition timeline.

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CMS-1500 Claim Form 2-Part Continuous (White/Canary Paper Stock)	CMS-1500 2-Part Continuous (White/White Paper Stock)	UB-04 Hospital Claim Form 2-Part Continuous	UB-04 Hospital Claim Form 1-Part Continuous

CMS-1500 Claim Form, 2-Part Continuous Feed Style. White/Canary Paper Stock. Per federal regulations, all healthcare providers must use the CMS-1500 Form for specific types of billing. The CMS-1500 Form accommodates reporting of the National Provider Identifier which must be used by all HIPAA-covered entities. Contact us today at 877-212-1220 for a free sample.	CMS-1500 Claim Form, 2-Part Continuous. White/White Paper Stock. Approved Government CMS-1500 Claim Forms. Contact us today at 877-212-1220 for a free sample.	UB-04 Hospital Claim Form 2-Part Continuous. Includes required red copy and duplicate white copy. Contact us today at 877-212-1220 for a free sample.	UB-04 Hospital Claim Form 1-Part Continuous. Contact us today at 877-212-1220 for a free sample.


CMS-1500 Claim Form 3-Part Continuous	CMS-1500 2-Part Snap-Set	CMS-1500 Claim Form Single Sheet Laser	UB-04 Hospital Claim Form Laser Format

CMS-1500 Claim Form 3-Part Continuous Feed Style. Per federal regulations, all healthcare providers must use the CMS-1500 Form for specific types of billing. The CMS-1500 Form accommodates reporting of the National Provider Identifier which must be used by all HIPAA-covered entities. Contact us today at 877-212-1220 for a free sample.	CMS-1500 Claim Form 2-Part Snap-Apart Set. The CMS-1500 Form accommodates reporting of the National Provider Identifier which must be used by all HIPAA-covered entities. Contact us today at 877-212-1220 for a free sample.	CMS-1500 Claim Form Single Sheet Laser. Per federal regulations, all healthcare providers must use the CMS-1500 Form for specific types of billing. The CMS-1500 accommodates reporting of the National Provider Identifier which must be used by all HIPAA-covered entities. Printed in OCR Dropout red ink. Approved Government CMS1500 Claim Forms. Contact us today at 877-212-1220 for a free sample.	UB-04 Hospital Claim Form Laser Single Sheet Format. Guaranteed compliant UB-04 Billing Forms. Contact us today at 877-212-1220 for a free sample.


CMS-1500 Claim Form 1-Part Continuous

CMS-1500 Claim Form, 1-Part Continuous Feed Style. Per federal regulations, all healthcare providers must use the CMS-1500 Form for specific types of billing. The CMS-1500 Form accommodates reporting of the National Provider Identifier which must be used by all HIPAA-covered entities. Contact us today at 877-212-1220 for a free sample.