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What you need to know about Healthcare Claim Forms...

Compliance is critical for medical claim forms...

If you le a claim with a form that is not up to date and fully compliant the payer may reject the form, causing a delay in you, the provider, receiving payment.

What makes a form compliant or non-compliant?

A number of factors... for starters it must adhere to strict printing standards that govern the layout, the paper and the ink. It must also have accurate content like the NPI - the National Provider Identier and it must conform to the HIPAA - Health Insurance Portability and Accountability Act.

How can I be sure that my forms are up-to-date and fully compliant?

Two things... rst of all, ask us. We can check your current supply of forms. Secondly be sure to order from this catalog. All the forms inthis catalog were developed in conjunction with all the governing agencies including the NUCC - National Uniform Claim Committee, the NUBC - National Uniform Billing Committee, the CMS - Centers for Medicare and Medicaid Services, the HHS - Health and Human Services agency of the US Govern- ment and the AHA - American Hospital Association. We are the only provider selected to work exclusively with these agencies in the development of the current forms and are in constant contact with all agencies to be on top of the latest revisions and requirements.

Table of Contents

Form CMS-1500 - page 3 For private practice providers and anyone billing within the non-institutional medical industry

Form UB-04 - page 4 For hospitals, skilled nursing, home health care facilities and other institutional healthcare providers

Attending Dentist’s Statements - page 5 All the claim forms ocially licensed by the ADA and supported by the most popular dental software packages

Compatible Envelopes - page 6 Standard and Jumbo envelopes compatible with the CMS-1500, UB-04 and ADA forms

CMS-1500 Form Filler Software - page 7 For private practice providers and anyone billing within the non-institutional medical industry

Form UB-04 Form Filler Software - page 8 For hospitals, skilled nursing, home health care facilities and other institutional health care providers

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