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NPI and Paper Claim forms CMS-1500 Professional UB-04-2025

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The document provides guidelines for healthcare providers on submitting paper claims (CMS-1500, UB-04, and ADA-2006) to Medical Assistance. It emphasizes the importance of using the 13-digit PROMISe™ legacy number as the primary identifier and the NPI number as a secondary identifier to avoid processing delays. The document also encourages providers to ensure accurate information is submitted for timely payment.

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What is the difference between the CMS-1500 claim form and the UB 04 form?

The CMS-1500 form is the go-to for professional services provided by individual healthcare providers, while the UB-04 form is indispensable for institutional providers managing complex care and hospital services.

What is the difference between CMS 1500 and ub04?

The two most common claim forms are the CMS-1500 and the UB-04. These two forms look and operate similarly, but they are not interchangeable. The UB-04 is based on the CMS-1500, but is actually a variation on itits also known as the CMS-1450 form.

What block does the NPI number go on the CMS-1500 form?

Enter the NPI of the referring/ordering physician listed in item 17 as soon as it is available. The NPI must be entered within the confines of the larger box. The NPI may be reported on the CMS-1500 Form (08-05) as early as January 1, 2007. An invalid NPI will cause the claim to be rejected as unprocessable.

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