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NPI and Paper Claim forms CMS-1500 Professional UB-04-2026

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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 entering the NPI number as a secondary identifier to avoid processing delays. The document also encourages providers to visit the PROMISe™ website for additional information.

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Click ‘Get Form’ to open the CMS-1500 or UB-04 form in the editor.
Begin by entering the 13-digit PROMISe™ legacy number as the primary identifier in the designated field. This is crucial for processing your claim.
Next, input your NPI number as a secondary identifier. Ensure that this is accurately placed to avoid any delays.
For CMS-1500 forms, complete all required fields such as patient information, provider details, and service codes. Double-check for accuracy.
For UB-04 forms, ensure you fill out sections related to institutional claims, including facility information and billing details.
Review all entries for completeness and correctness before submitting your claim through our platform.

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

Who typically uses a UB-04 form?

Your healthcare provider - You can request a sample UB-04 form from your healthcare provider. They may have a blank copy of the form that you can use as a reference. Commercial printing companies - Many companies specialize in printing medical forms, including the blank UB-04 form.

Where is NPI on UB04?

Please ensure a different NPI is listed in box 56 (NPI) for rendering and box 76 (attending NPI) for billing on UB-04/CMS-1450 forms, which can be found by visiting the Centers for Medicare Medicaid Services (CMS) website . For questions, please contact Superiors Provider Services at 1-877-391-5921.

What is a UB 04 form NPI?

Providers sending professional and supplier claims to Medicare on paper must use Form CMS-1500 in a valid version. This form is maintained by the National Uniform Claim Committee (NUCC), an industry organization in which CMS participates.

What is a UB04 form used for?

➜ Hospitals General hospitals, childrens hospitals, and specialty hospitals all use the UB-04 form to bill for inpatient and outpatient services, including surgeries, diagnostic tests, and other medical treatments.

Does CMS accept paper claims?

The rendering providers NPI and taxonomy, if applicable, should be entered in box 24J on the CMS 1500. This will ensure proper processing and payment for services.

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

The UB-04 claim form is used to submit claims for outpatient services by institutional facilities (for example, outpatient departments, Rural Health Clinics and chronic dialysis centers).

NPI and Paper Claim forms CMS-1500 Professional UB-04-2026

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How to use or fill out NPI and Paper Claim forms CMS-1500 Professional UB-04 with our platform

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Who typically uses a UB-04 form?

Where is NPI on UB04?

What is a UB 04 form NPI?

What is a UB04 form used for?

Does CMS accept paper claims?

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

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