Get 2017 Claim Forms

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).

On the other hand, the HCFA-1500 (CMS 1500) is a medical claim form employed by individual doctors & practices, nurses, and professionals, including therapists, chiropractors, and out-patient clinics. It is not typically hospital-oriented. Both forms help to process the medical claim of a patient.

The UB-04 (CMS-1450) form is the claim form for institutional facilities such as hospitals or outpatient facilities. This would include things like surgery, radiology, laboratory, or other facility services. The HCFA-1500 form (CMS-1500) is used to submit charges covered under Medicare Part B.

Medicare will accept any Page 3 type (i.e., single sheet, snap-out, continuous feed, etc.) of the CMS-1500 claim form for processing. To purchase forms from the U.S. Government Printing Office, call (202) 512-1800. The following instructions are required for a Medicare claim.

Created in 1977 as the Health Care Financing Administration (HCFA), HCFA was named the Centers for Medicare & Medicaid Services (CMS) on June 14, 2001. The agency has the following responsibilities: Administer the Medicare & Medicaid programs.

The Form HCFA-1500 answers the needs of many health insurers. It is the basic form prescribed by HCFA for the Medicare program for claims from physicians and suppliers, except for ambulance services.

The CMS-1500 form is the standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of ...

CMS-1500 Form (sometimes called HCFA 1500): This is the standard health insurance claim form used for submitting physician and professional claims to bill Medicare providers. In other words, the CMS-1500 is used for individual provider claims and is used to submit charges under Medicare Part-B.