TMPPM 2010 > Volume 1, General Information > Section 6: Claims Filing > UB-04 CMS-1450 Claim Filing Instructions > UB-04 CMS-1450 Claim Form (Paper) Billing

   
 

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

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

Note: To avoid claim denial, only the provider's NPI should be placed in form locators 76-79 of the UB-04 CMS-1450 claim form or in the referring provider 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 provider identifier. Claims without a provider name, address, and provider identifier cannot be processed.

Refer to: Subsection 6.6.4, "UB-04 CMS-1450 Instruction Table" in this section.


Texas Medicaid & Healthcare Partnership
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