Forms

Commercial Forms

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ValueOptions® of Tennessee

CMS-1500 (08/05) and CMS-1450 (UB04) Health Insurance Claim Forms

We are unable to provide a CMS-1450/CMS-1500 form on-line, since these forms use a red ink which enables them to be scannable using OCR equipment. This ink cannot be duplicated by regular PC color printers, and therefore, we ask providers to please submit pre-printed, red-ink CMS forms, which can be obtained from your local office supply retailers. 

We would like to stress, also, that all CMS-1450/CMS-1500 forms are not equal.  There are older versions of the forms which cause scanning difficulties, so you may want to check with your vendor to be sure you have the proper version of the form.  You may also go out to the site at Centers for Medicare and Medicaid Services (CMS)  and choose CMS-1450/CMS-1500 to view a copy of a proper form.  We stress again that a copy of the form printed from their site will not be scannable and will result in delayed processing and payment of claims.