Type information on the screen as it would be typed on the form itself.
The map is available under the Claim Form tab.
Additionally, seven changes have been made to the Provider Characteristics code set; six new codes have been added and one code has been revised.
The complete code set is available under the "Code Sets" tab. Questions or comments about the code set or the revisions can be emailed to: The updated instruction manual, Version 6. All changes that were made to the instructions following the July release have been incorporated into this version of the instruction manual.
A change log showing all of the updates is also available under the Claim Form tab.
Any interim changes, clarifications, or corrections to the instructions following this release will be posted on the NUCC website. The NUCC does not process claims. Send completed forms to the appropriate payer. The results of the survey are available here.
Overall, the survey found that there continues to be significant use of the Form within the industry. The top reasons for using the Form among all stakeholders were 1 attachments; 2 coordination of benefits; 3 workers' compensation, property and casualty, and auto claims; 4 claims for specific services; and 5 primary claims.
The NUCC plans to use the information from this survey in its general work on the professional claim and its data content. This survey is not an indication of any specific changes being considered for the Form. If you have any questions about the survey or results, please email This email address is being protected from spambots.
The form has been renewed in its current format, with no changes to the OMB number, data fields, or other text on the form. The following resources will assist your organization in implementing the revised form:Instructions and guideline for CMS claim form and UB 04 form.
Tips and updates. Detailed review of all the fields and box in CMS claim form and UB 04 form and ADA form.
Product Features cms (02/12) claim forms are available for use with the ICD codes. Contact your customer service support team about products, services and more.
CMS KIDNEY DISEASE PROGRAM BILLING INSTRUCTIONS,INTRODUCTION These billing instructions have been prepared to provide proper procedures and instructions for the Kidney Disease Program providers who use the CMS () form.
CMS Required Attachments Type of CMS Medical Bill Required Attachment; DME: Bill or invoice for the item(s) dispensed and a copy of the physician's prescription (order) for the item(s).
Product Description These are the new (version 02/12) CMS claim forms. They are continuous 2-part froms for pin-fed printers.
They are letter size. /2" x 11".