MedicaidAdministrativeMedium impact
Inappropriate Use of Laser-Generated UB-04 Paper Claims
Illinois Medicaid - HFS·IL · General Surgery, Nephrology·Provider Notice
Effective date
Apr 1, 2009
We identified it
Jun 21, 2026
Summary
Starting April 1, 2009, laser-generated black and white UB-04 paper claim forms will be returned unprocessed due to imaging system incompatibility. Providers must purchase and use only original red-ink UB-04 forms from approved vendors.
Action Required
By April 1, 2009: Billing team must stop using laser-generated or photocopied UB-04 forms. Purchase only original red-ink UB-04 forms from approved vendors for all paper claim submissions. Contact Bureau of Comprehensive Health Services at 1-877-782-5565 for questions. Claims submitted on laser-generated forms will be returned unprocessed.