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Dental and Medical Insurance Claim Forms and Mailing Envelopes

UB-04 claim forms should be used by hospitals to bill inpatient facility charges. All other services should use the CMS-1500 claim form.

Please note that all claim forms (Dental, CMS-1500, and UB-04) are the new format, required as of May 2007

Forms are not available for priority shipping. Standard ground shipping only.

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