UB04 Claim Forms 1 part Laser/Inkjet 2500 Sheets NLCFUB041

ONE PART LASER CUT SHEETS

UB04 Claim Forms 1 part Laser/Inkjet  Government approved. (2500 sheets per case)

NLCFUB041

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