PDF
Word
Instructions for Form UB-04, CMS-1450 Nd Health Enterprise Mmis Claim Form - North Dakota
This document contains official instructions for Form UB-04 , and Form CMS-1450 . Both forms are released and collected by the North Dakota Department of Health and Human Services.
FAQ
Q: What is Form UB-04?
A: Form UB-04 is a standardized claim form used for submitting health insurance claims for services provided in a healthcare facility.
Q: Who uses Form UB-04?
A: Healthcare facilities, such as hospitals and nursing homes, use Form UB-04 to submit health insurance claims.
Q: What is CMS-1450?
A: CMS-1450 is another name for Form UB-04. It is the official form used for submitting health insurance claims.
Q: What is Health Enterprise MMIS?
A: Health Enterprise MMIS stands for Health Enterprise Medicaid Management Information System. It is the system used in North Dakota for processing Medicaid claims.
Q: What is the purpose of the North Dakota UB-04 form?
A: The North Dakota UB-04 form is used to submit healthcare claims to the Health Enterprise MMIS system for Medicaid reimbursement.
Instruction Details:
- This 11-page document is available for download in PDF;
- Actual and applicable for the current year;
- Complete, printable, and free.
Download your copy of the instructions by clicking the link below or browse hundreds of other forms in our library of forms released by the North Dakota Department of Health and Human Services.
Download Instructions for Form UB-04, CMS-1450 Nd Health Enterprise Mmis Claim Form - North Dakota
1
2
3
4
5
6
7
8
9
10
11
