Va. Admin. Code tit. 12, agency 5, ch. 218, form FORMS (12VAC5-218) - FORMS (12VAC5-218)
National Uniform Billing Committee Uniform Billing Form UB-04 (undated)
Centers for Medicare and Medicaid Health Insurance Claim Form, Sample Form, CMS 1500 (approved 2/12)
Notes
Statutory Authority: ยงยง 32.1-12 and 32.1-276.6 of the Code of Virginia.
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No prior version found.