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Ncpdp.org/Products/Universal-Claim-Forms. Product Identification Description PUCFCC PUCF2PT Credit Card style form Version 5 continuous feed form Version 5 laser form PUCF-D02PT v1. Purchasing the Universal Claim Forms Updated 01/2015 Universal Claim Forms Purchase The National Council for Prescription Drug Programs NCPDP Universal Claim Forms are purchased from CommuniForm. Information is available at http //www. To discuss please contact Alex Pallas. NCPDP has published the Manual Claim Forms Reference Guide for pharmacies or other providers who are filling out the Version D Universal Claim Form or the Workers Compensation/Property and Casualty Universal Claim Forms. The guide is also available with NCPDP membership. This guide is copyrighted and cannot be reproduced or distributed. External Code List Data Element Values The back of the Version D Universal Claim Form and the Workers Compensation/Property and Casualty Universal Claim Forms contain common data element values from the NCPDP External Code List document. 1 Version D. 0 continuous feed form Version D. 0 laser form 02/2013 note version 1. 1 will be sunsetted as v1. 2 is used WUCF1PT Workers Compensation/Property and Casualty Version 5 and above laser form Previous applicable DAH 3-97 DAH 2PT UCF L1 Note The Workers Compensation/Property and Casualty Universal Claim Forms were built to support Telecommunication Standard Version 5 and above including Version D. Other Solutions Contractual Arrangement PDF Template you must have IT resources for implementation. This guide is also for use by health plans/processors who are accepting these claim forms. The guide is available via the customeronly web page of CommuniForm for entities that purchase the form s. There is limited real estate to the back of the forms so the Manual Claim Forms Reference Guide should be used for more information* Page 1. 1 Version D. 0 continuous feed form Version D. 0 laser form 02/2013 note version 1. 1 will be sunsetted as v1. 2 is used WUCF1PT Workers Compensation/Property and Casualty Version 5 and above laser form Previous applicable DAH 3-97 DAH 2PT UCF L1 Note The Workers Compensation/Property and Casualty Universal Claim Forms were built to support Telecommunication Standard Version 5 and above including Version D. 2 is used WUCF1PT Workers Compensation/Property and Casualty Version 5 and above laser form Previous applicable DAH 3-97 DAH 2PT UCF L1 Note The Workers Compensation/Property and Casualty Universal Claim Forms were built to support Telecommunication Standard Version 5 and above including Version D. Other Solutions Contractual Arrangement PDF Template you must have IT resources for implementation. 1 Version D. 0 continuous feed form Version D. 0 laser form 02/2013 note version 1. 1 will be sunsetted as v1. 2 is used WUCF1PT Workers Compensation/Property and Casualty Version 5 and above laser form Previous applicable DAH 3-97 DAH 2PT UCF L1 Note The Workers Compensation/Property and Casualty Universal Claim Forms were built to support Telecommunication Standard Version 5 and above including Version D. Other Solutions Contractual Arrangement PDF Template you must have IT resources for implementation.

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