5.7.1.4 CMS-1500 Paper Claim Form Example 5.7.1.5 UB-04 CMS-1450 Paper Claim Form InstructionsThe following services must be billed using the UB-04 CMS-1450 paper claim form or electronic claim format when requesting payment:
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• Providers are responsible for obtaining these forms from a supplier of their choice. Refer to: Section 5.7.1.11, "UB-04 CMS-1450 Paper Claim Form Example". |
Hospital ambulatory surgical center (HASC)
