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Medicare Advantage Individual PPO Claims Alert: Please check your patient records and submit claims using the correct MXJ prefix to avoid potential denials.Learn More
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Paper Claims

If you are still submitting paper claims, use the following forms to submit your claims:

Professional Claims

Professional claims must be submitted using the current version of the CMS-1500 form (version 02/12) on original red-ink-on-white-paper. To order a supply of forms, please use your normal process.

Institutional Claims

Institutional claims must be submitted using the current version of the UB-04 form. Visit the NUBC website to find details for using and ordering the new form.