Medi-Cal Education & Outreach Provider Relations
Box UB-04 • Billing Tips

Following these billing tips will help prevent rejections, delays and/or denials of claims.

Paper claims submitted with alignment problems may be rejected or may delay processing and payment of the claim. Please be sure to use the most up-to-date software for these forms. There are many vendors who provide updated software for these new forms.

Please remember to use black ink only and 10-point font (not to exceed the field size). Do not use script or italic font. Document scanning equipment can scan only typed or computer-printed forms.

Below are examples of correctly and incorrectly completed forms:

Incorrect alignment boxes 44-47Correct alignment boxes 44-47

Incorrect alignment boxes 52-56
Correct alignment boxes 52-56

Incorrect alignment boxes 76-79
Correct alignment boxes 76-79

If you have any questions, please call the Telephone Service Center (TSC) at 1-800-541-5555.