We recommend that you explore how to use UHIN to submit claims electronically by reviewing our HIPAA Transaction Standard Companion Guide.
However, if you do not wish to use UHIN and to ensure timely payment of your claim, it's important that the claim is complete and legible.
Also, be sure to include the following provider information, so our provider records remain accurate.
NOTE: Please notify us when you have a change of name, tax identification number, or address.
Click here for the Provider Update Form.
HCFA 1500
| Description |
Location on the HCFA 1500 Form |
| Federal Tax ID Number |
Box 25 |
Rendering Provider's Name
(Including degrees or credentials)
Or
Supplier's Name
|
Box 31 |
| Rendering Provider's NPI # |
Box 24-J |
| Service Facility Name & Location Address |
Box 32 |
| Billing Provider's Name, Address, & Phone # |
Box 33 |
| Billing Provider's NPI # |
Box 33-a |
UB-04
| Description |
Location on the UB-04 Form |
| Service Facility Name, Location Address, & Phone # |
Box 1 |
| Billing Provider's Name, Address, & Phone # |
Box 2 |
| Federal Tax ID Number |
Box 5 |
| Service Facility NPI # |
Box 56 |