Claim Submission Forms

The CMS-1500 and UB-04 (also referred to as CMS-1450) forms are common among state Medicaid plans and Medicare plans. Click on the images below to learn more about these forms.



You may be required to use a different method or form, depending on specific requirements from your state Medicaid Agency or commercial plan. Contact the Medicaid Agency or plan to be billed for detailed information on how to submit claims.