Claim Forms

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Claim Forms

Wilmer offers the most up-to-date claim forms with guaranteed compliance on the printing of the forms. Covering dental and physicians in all sectors, the UB04's for hospitals and CMS1500's for smaller practices, is a necessity. The Centers for Medicare and Medicaid Services require claims to be submitted on the CMS1500's or the UB04's. All dental forms are offered in black ink with no barcode. The physician claim forms can be found in the standard OCR red ink, both with and without barcodes. Ordered in per carton quantities, our offering is very extensive to meet all your clients needs. Be sure to check out our new CMS1500 Change Preview Flyer to see how the new forms will look with all the changes.

CMSCMS

100% guaranteed compliance. For physicians, the CMS 1500 meets The Centers for Medicare and Medicaid Services guidelines. CMS 1500 (02/12) claim forms are available for use with the ICD-10 codes. All returns must be made within 60 days of invoice by calling customer service and receiving a return authorization number. View Product

UB04UB04

100% guaranteed compliance. For hospitals, the UB04 meets The Centers for Medicare and Medicaid Services guidelines. View Product

ADAADA

100% guaranteed compliance. Meets The American Dental Associations guidelines. New (2012) and old ADA forms available. View Product