Universal Claim Forms (UCF)

The NCPDP Universal Claim Forms may be purchased from our vendor, CommuniForm LLC. The forms can be ordered by Phone at 877.817.3676, Fax 866.308.2036 or via the web.

CommuniForm supports the:

Healthcare/Group Health/Third Party/Commercial Claims Billing Forms:

  • Version 5 continuous feed form (old name DAH 2PT) (new name PUCF2PT)
  • Version 5 laser form (old name UCF L1) (new name PUCF1PT)
  • Version D.0 continuous feed form (PUCF-D02PT)
  • Version D.0 laser form (PUCF-D01PT)

Workers' Compensation/Property and Casualty Forms:

  • Pharmacy Workers' Compensation/Property and Casualty laser form (WUCF-1PT)

Other Forms:

  • Credit Card style form (old name DAH 3-97) (new name PUCFCC)

December 2012 The California Division of Workers' Compensation Medical Billing and Payment Guide has been modified to cite the correct official NCPDP Workers' Compensation/Property & Casualty Claim Form version 1.1 – 05/2009. Click here for the updated guide.

Industry Moving to D.0 version 1.2 UCF

Due to changes required for Medicare Part D processing of claims with dates of service on or after February 28, 2013, a new version of the NCPDP Telecommunication vD.0 Continuous Feed (PUCF-D02PT) and Laser Universal Claim Form (PUCF-D01PT) have been created. Medicare Part D sponsors will be required to submit additional fields to CMS based on the CMS notice dated October 1, 2012 referencing Revised Reporting Requirements for Prescriber Identifiers and Other Prescription Drug Event Fields. Pharmacies currently submit these fields on real-time claims and the UCFs have been updated to accommodate.

 
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