0
Answered

UB-04 Form Version to Print Claim & Text

Damon 2 years ago updated by dan 2 years ago 1

Hello...I am having the same issue that was resolved in a previous post with the following:

In your download there are two versions, the one called "for text only" is most likely what you opened. I will send the version that will print the red claim and typed text to your email so you have it.

When I print the completed form it is only the text that is printing, not the red claim content as well.

Also, is there a version of the fillable PDF where the red content is black instead?  We use email fax when the file is dragged to email and faxed directly, but when received using the red content version it is blurry or faint.

Thank you,

Answer

Answer
Answered

Hi Damon,

The CMS 1500 PDF has two versions, but the UB-04 PDF is only text only.  The reason is... when you print the UB-o4 on blank paper, the sides of the form are often cut off by a regular office printers, and we do not have the back page.  Because of that, your claim might get rejected when submitted.  

However, I can provide you a version that prints both form and text.  I do not have b/w version, because most claims are processed using the OCR red dropout ink.  I will send it to your email account for you to try.

Best regards,

Dan

Answer
Answered

Hi Damon,

The CMS 1500 PDF has two versions, but the UB-04 PDF is only text only.  The reason is... when you print the UB-o4 on blank paper, the sides of the form are often cut off by a regular office printers, and we do not have the back page.  Because of that, your claim might get rejected when submitted.  

However, I can provide you a version that prints both form and text.  I do not have b/w version, because most claims are processed using the OCR red dropout ink.  I will send it to your email account for you to try.

Best regards,

Dan