Claims and Appeals Resources
Access forms and documents needed for submitting claims and appeals.
| Type | Title | Date | Plan Type |
|---|---|---|---|
 |
Billing Requirements: Institutional Claims
|
5/31/2016 | |
|
Billing Requirements: Professional Claims
|
5/31/2016 | |
|
Form: Claim Adjustments and Project
|
1/25/2018 | |
|
Form: CMS-1500 Claim
|
1/25/2018 | |
|
Form: Credit Balance Refund Data Sheet
|
1/25/2018 | |
|
Form: EFT Authorization
|
1/25/2018 | |
|
Form: EFT Guide and Authorization
|
1/25/2018 | |
|
Form: ERA Authorization
|
1/25/2018 | |
|
Form: ERA Guide and Authorization Form
|
1/25/2018 | |
|
Form: Medicare Part D Vaccine and Administration Claim
|
1/25/2018 | |
|
Form: Request for Claim Review
|
1/25/2018 | |
|
Guide: EDI Claims Companion Guide for 5010
|
1/25/2018 | |
|
Guide: Electronic Health Care Claim Payment / Advice (835) Companion Guide for 5010
|
1/25/2018 | |
|
Guide: Electronic Health Care Eligibility Benefit Inquiry and Response (270 / 271) Companion Guide for 5010
|
1/25/2018 | |
|
Instructions: Corrected Claims
|
1/25/2018 |