Submitting paper claim – BCBS
Filing your claims electronically is both quicker and more cost effective. However, there may be times
when it is necessary to file paper claims. The CMS-1500 (or equivalent) and the UB-04 are the claim
forms accepted by BCBSF.
CMS-1500
The National Uniform Claim Committee (NUCC) determines the data elements and design of the CMS-
1500. For additional information, including instructions on completing the form, refer to www.nucc.org.
UB-04
The National Uniform Billing Committee (NUBC) and the Florida State Uniform Billing Committee (SUBC)
determine the data elements and design of the UB-04. These data elements are published in the National
Uniform Billing Data Element Specifications Manual, which contains instructions for completing the UB-04
claim form.
If you would like to enroll in the UB-04 subscription service to receive a complete UB-04 manual and
updates, visit www.nubc.org. You may also contact the Florida Hospital Association Management
Corporation at www.fha.org or (407) 841-6230.
Filing your claims electronically is both quicker and more cost effective. However, there may be times
when it is necessary to file paper claims. The CMS-1500 (or equivalent) and the UB-04 are the claim
forms accepted by BCBSF.
CMS-1500
The National Uniform Claim Committee (NUCC) determines the data elements and design of the CMS-
1500. For additional information, including instructions on completing the form, refer to www.nucc.org.
UB-04
The National Uniform Billing Committee (NUBC) and the Florida State Uniform Billing Committee (SUBC)
determine the data elements and design of the UB-04. These data elements are published in the National
Uniform Billing Data Element Specifications Manual, which contains instructions for completing the UB-04
claim form.
If you would like to enroll in the UB-04 subscription service to receive a complete UB-04 manual and
updates, visit www.nubc.org. You may also contact the Florida Hospital Association Management
Corporation at www.fha.org or (407) 841-6230.