TMPPM 2008 > Provider Information > Claims Filing > UB-04 CMS-1450 Claim Filing Instructions

5.6.2 UB-04 CMS-1450 Claim Form (Paper) Billing

Providers obtain the UB-04 CMS-1450 claim forms from a vendor of their choice.

Note: To avoid claim denial, only the provider's Texas license number is preceded by "TX" and should be placed in form locators 82 and 83 of the UB-04 CMS-1450 claim form or in the referring provider license number field on the electronic claim unless the client is a limited client.

Completed UB-04 CMS-1450 claims must contain the billing provider's full name, address, and/or provider identifier. A claim without a provider name, address, or provider identifier cannot be processed.

Refer to: "UB-04 CMS-1450 Instruction Table" .