CMS-1500 & UB-04 Paper Claim Submission: Requirements, Deadlines & How to Avoid Rejections

Navigating the complexities of paper claim submission for healthcare services requires meticulous attention to detail to ensure proper **claim adjudication** and avoid costly rejections. This guide outlines the essential requirements for both CMS-1500 and UB-04 forms, critical filing deadlines, and common pitfalls to help healthcare providers streamline their submission process.

Official CMS-1500 & UB-04 Paper Claim Guidelines

All paper CMS-1500 and UB-04 claims must be submitted on standard red claim forms. Using black and white versions, photocopied versions, faxed versions, or resized representations of the form that do not replicate the scale and color of the original is strictly prohibited. These non-standard forms will not be accepted because they can lead to issues with **OCR scanning** (Optical Character Recognition), making it impossible for automated systems to accurately process the claim data. Such claims will be returned with a request for resubmission on the proper claim form.

The CMS-1500 form is used for billing professional services claims, typically by physicians and non-physician practitioners. The UB-04 form, conversely, is used for institutional services claims, such as those from hospitals, skilled nursing facilities, and other inpatient or outpatient facilities.

Key Mandatory Fields for Paper Claims

Submitted paper claim forms must include all mandatory fields. Incomplete forms will be rejected and returned to the submitter with a letter stating the reason for rejection, requiring a new claim with the corrected information to be resubmitted for processing. While specific fields may vary slightly, generally, you must ensure the following are completed:

For CMS-1500 (Professional Claims):

• Patient Demographics (Name, DOB, Address, Gender)
• Insured Information (Policy Number, Group Number)
• Provider Information (Name, Address, NPI, Tax ID)
• Date(s) of Service
• Place of Service
• Procedure Codes (CPT/HCPCS)
• Diagnosis Codes (ICD-10)
• Charges for each service
• Referring Provider Information (if applicable)
• **Physician Signature Requirements on CMS-1500 Box 31**

For detailed information, refer to the CMS Medicare Claims Processing Manual, Chapter 25 – Completing and Processing Form CMS-1500 Data Set.

For UB-04 (Institutional Claims):

• Patient Demographics
• Insured Information
• Facility Information (Name, Address, NPI, Tax ID)
• Type of Bill
• Statement Covers Period (Admission/Discharge Dates)
• Revenue Codes
• HCPCS/CPT Codes (for outpatient services claims)
• Diagnosis Codes (ICD-10)
• Procedure Codes
• Charges and Total Charges
• Attending Physician Information

Consult the relevant chapters of the **official CMS Medicare Claims Processing Manual** for comprehensive UB-04 paper claim filing requirements.

Understanding Medicare Paper Claim Deadlines and Payer-Specific Guidelines

To avoid a filing deadline denial, rejected paper claims must be submitted in a timely manner. While the original content mentions