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

Hi -  I will send you the files directly to your email.  You will see 3 attachments, all PDFs.

Best regards,

Dan

Hi Joycelyn,

Yes - that option is still available.  I will send you that version to your email. 

Best regards,

Dan

Hi Earlisa,

Thanks for reaching out.  I sent the files to your email so you can forward them onto the user.

Best regards,

Dan

Hi Jeannette,

I sent you an updated version to use to your email. Font is now in bold so it will be darker for you. 

Best regards,

Dan

Hi Jeannette,

I sent you an updated version to use to your email.

Best regards,

Dan 

Hi Tim,

Thank you for clarifying, and sharing your insights.  I will be updating the form and will send you the revised version so you can enter in 8 digits for the Date of Admission. Thank you for pointing out the hover help as well. 

Thanks again,

Dan

Hi tlaclair,

It may be that you have copy and pasted into the field or that you have a space in the field. To check, first open in Adobe Reader, them press delete, and then backspace to clear the field.  The you should be able to type in the admission date,.

Best regards,

Dan

This is a great idea, to use the fillable form on a ipad.  

Many users have have tried over the years to use on a iPad and Chromebook, but it is a limitation of the Adobe Reader  software. There has not been a solution from Adobe Reader as of yet. Currently it will not allow for filling in the fields, and saving the document the way you can on a PC or Mac. Some have tried plugins, and even other PDF software, but nothing seems reliable on these devices yet. 

Best regards,

Dan

Hi,

If you can send a scan or picture with your phone of how it prints out for you, I can adjust the template to work with your printer. 
Send to: dan@fiachraforms.com

Best regards,

Dan