Skip to main content
  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
Elizabeth M. Whitehorn, Director

Provider Notice issued 01/26/09

​Inappropriate Use of Laser-Generated UB-04 Paper Claims

To:​ Participating Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers; Hospices; Renal Dialysis Facilities; and Ambulatory Surgical Treatment Centers (ASTCs)​
Date:​ January 26, 2009​
Re:​ Inappropriate Use of Laser-Generated UB-04 Paper Claims ​

The department utilizes a claim imaging system for scanning paper claims.  All department-issued claim forms, as well as the UB-04, are created with a red-ink background that allows the entries, completed in black or dark blue ink, to image clearly.

 

The department receives a significant number of black and white laser-generated UB-04 facsimiles for processing.  The black and white format of these claims interferes with the imaging process.

 

All providers are informed in the Handbook for Providers of Medical Services, Chapter 100, General Policy and Procedures, Topic 112.41, that only original billing forms should be submitted to the department for processing.  Effective with claims received on and after April 1, 2009, the department will return all laser-generated UB-04 forms to the provider. 

 

Providers must purchase the UB-04 from a vendor of their choice.

 

Any questions regarding this notice should be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

                                                                       

Theresa A. Eagleson, Administrator

Division of Medical Programs