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UB-40 and CMS-1500 are the two most common claim forms for submitting to insurance companies.
When a physician has a private practice but performs services at an institutional facility such as a hospital or outpatient facility, the CMS-1500 form would be used to bill for their services. The UB-04 (CMS-1450) form is the claim form for institutional facilities such as hospitals or outpatient facilities.
How to Complete an Expense Reimbursement Form: Add personal information. Enter purchase details. Sign the form. Attach receipts. Submit to the management or accounting department.
Types of Insurance Claims Burglary and Theft. Burglary and theft are the most common commercial insurance claims filed by businesses. Water and Freezing Damage. Wind and Hail Damage. Fire. Slips and Falls by Customers. Customer Injury and Property Damage. Product Liability. Struck by an Object.
Once logged in, click on Make a request on the apps homepage, then on Submit a claim. Provide the requested information. Take a picture of your documents to upload them to the app: medical bill, prescription, and proof of payment. Validate your request.
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How to get reimbursed in 3 steps: Pay your healthcare professional. Take a photo of your bills, medical prescriptions, or any other useful proof for the reimbursement of your care, and send them via Easy Claim. Your reimbursement claim is then processed by our teams.
A number of things were added to the UB92 form when it underwent the revision to become UB04. The main change is the addition of the field in which to input a National Provider Identifier (NPI). Additional fields were also added like more diagnosis code fields.
Individual practitioners should use HCFA-1500. Medical facilities should use UB-92, which is now referred to as UB-04. Lets define individual practitioners as non-institutional health care providers or medical professionals, such as individual doctors, nurses, and therapists. They would use the HCFA-1500 form.

april international claim form pdf