CMS form 1450

The CMS1450/UB04 is a uniform billing form used by institutional providers for paper submission of claims. Details on the form and CMS instructions for completion are found in Ch 25 of the CMS Claims processing manual. For electronic submissions institutional providers use the ANSI ASC X12N 837I. CMS Medicare Learning Network, Medicare Billing: Medicare Billing: 837I and Form CMS-1450ANSI