Home
Forms Library
2012 Print Vendor Registration Form (PDF) - UB Professional Staff

2012 Print Vendor Registration Form (PDF) - UB Professional Staff-2025

2012 Print Vendor Registration Form (PDF) - UB Professional Staff Preview on Page 1

See details

4 out of 5

35 votes

The document is an invitation to the University at Buffalo's 'Greener Shade of Blue & You Day' event on September 18, 2012, aimed at promoting environmental stewardship among students, faculty, and staff. The event will feature vendors and representatives sharing information on sustainability practices. It invites sponsorship from organizations and provides details for registration and contact information.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

The best way to modify 2012 Print Vendor Registration Form (PDF) - UB Professional Staff in PDF format online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Working on documents with our comprehensive and user-friendly PDF editor is simple. Make the steps below to fill out 2012 Print Vendor Registration Form (PDF) - UB Professional Staff online easily and quickly:

Sign in to your account. Log in with your email and password or register a free account to try the service before upgrading the subscription.
Upload a form. Drag and drop the file from your device or import it from other services, like Google Drive, OneDrive, Dropbox, or an external link.
Edit 2012 Print Vendor Registration Form (PDF) - UB Professional Staff. Easily add and highlight text, insert pictures, checkmarks, and symbols, drop new fillable fields, and rearrange or remove pages from your document.
Get the 2012 Print Vendor Registration Form (PDF) - UB Professional Staff accomplished. Download your updated document, export it to the cloud, print it from the editor, or share it with other people through a Shareable link or as an email attachment.

Benefit from DocHub, the most straightforward editor to rapidly manage your paperwork online!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the most common paper claim form or format used in the medical office?

As a medical billing company for various doctors and facilities, we understand that knowing which form to use is the first step to filing a successful claim. UB-40 and CMS-1500 are the two most common claim forms for submitting to insurance companies.

How would you enter a modifier on the claim form?

You enter the pricing modifier directly to the right of the procedure code on the claim. Most providers use the electronic equivalent of this form to bill Medicare for professional (pro-fee) services. Claims that do not have the pricing modifier in the first position may encounter processing delays.

What is a 837 professional claim?

The 837P is the standard format health care professionals and suppliers use to submit health care claims electronically. The ANSI ASC X12N 837P Version 5010A1 is the current electronic claim version. Find more information on the ASC X12 website.

What number on the CMS-1500 form is the ICD-10 CM code reported?

ICD-9-CM (or ICD-10-CM, once mandated) diagnosis codes must be entered in Box 21 only.

What is box 33 on CMS 1500?

33. Billing Provider Information Phone Number name, address, and phone number of provider requesting to be paid for services rendered. Billing provider address on both a CMS 1500 and UB must be the physical location; not a PO Box.

Can ICD-10-CM be reported on CMS 1500?

Reminder: Do not report ICD-10-CM codes for claims with dates of service prior to implementation of ICD-10-CM, on either the old or revised version of the CMS-1500 claim form. For form version 08/05, report a valid ICD-9-CM code. Enter up to four diagnosis codes.

What is box number 19 in CMS 1500?

Box 19 is commonly used on paper claims for data not otherwise accommodated by the CMS-1500 claim form. Data entered in this field will print but will NOT export electronically. Please contact your payer to determine where the data is expected.

What number on the CMS 1500 form is the ICD-10-CM code reported quizlet?

ICD-10-CM diagnosis codes are entered in Block 21 of the CMS-1500 claim.

2012 Print Vendor Registration Form (PDF) - UB Professional Staff-2025

Here's how it works

The best way to modify 2012 Print Vendor Registration Form (PDF) - UB Professional Staff in PDF format online

Complete this form in 5 minutes or less

Got questions?

What is the most common paper claim form or format used in the medical office?

How would you enter a modifier on the claim form?

What is a 837 professional claim?

What number on the CMS-1500 form is the ICD-10 CM code reported?

What is box 33 on CMS 1500?

People also ask

Can ICD-10-CM be reported on CMS 1500?

What is box number 19 in CMS 1500?

What number on the CMS 1500 form is the ICD-10-CM code reported quizlet?

Related links

Try more PDF tools

2012 Print Vendor Registration Form (PDF) - UB Professional Staff-2025

Here's how it works

The best way to modify 2012 Print Vendor Registration Form (PDF) - UB Professional Staff in PDF format online

Complete this form in 5 minutes or less

Got questions?

What is the most common paper claim form or format used in the medical office?

How would you enter a modifier on the claim form?

What is a 837 professional claim?

What number on the CMS-1500 form is the ICD-10 CM code reported?

What is box 33 on CMS 1500?

Related Searches

People also ask

Can ICD-10-CM be reported on CMS 1500?

What is box number 19 in CMS 1500?

What number on the CMS 1500 form is the ICD-10-CM code reported quizlet?

Related links

Try more PDF tools