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claim form. However, rejected institutional claims may be returned on the new UB04 claim form regardless of the version filed. CMS1450 UB04) Specifications CMS-1450 (UB04) Field Specifications Effective March 1, 2007, BlueCross BlueShield of Tennessee began accepting the new UB04 claim form. Please refer to the following documentation for appropriate formatting when submitting data in these new or updated form locator (FL) fields. Form Locator Description FL 1 FL 2 FL 3 FL 10 FL 11 FL 12 .

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