Submitting Claims

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)
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


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