Instructions For Completing The Ub 04

Medicare Claims Processing Manual Crosswalk

Chapter 25 - Completing and Processing the Form CMS-1450 Data Set . Table of Contents (Rev. 10880, 08-06-21) Transmittals for Chapter 25. 10 - Reserved . 70 - Uniform Bill - Form CMS-1450 70.1 - Uniform Billing with Form CMS-1450. 70.2 - Disposition of Copies of Completed Forms. 75 - General Instructions for Completion of Form CMS-1450 for Billing

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Billing Manual - PA Health & Wellness

PA Health & Wellness only accepts the CMS 1500 (2/12) and CMS 1450 (UB-04) paper claim forms. Other claim form types will be rejected and returned to the provider. Professional providers and medical suppliers complete the CMS 1500 (2/12) form and institutional providers complete the CMS 1450 (UB-04) claim form. PA Health & Wellness