New Claim Forms

2/7/2007 11:19:25 AM
Below are the effective dates that CCHP will be using to comply with Medicare regulations for the new claim forms:

CMS-1500 (formerly HCFA-1500)
*January 1, 2007 - March 31, 2007 is the dual-use period where providers can use the HCFA-1500 and/or CMS 1500

*April 2, 2007 CCHP will accept only the new CMS 1500 (version 08/05)

UB-04 (formerly UB-92)
*March 1, 2007 - May 22, 2007 is the dual-use period where facilities can use the UB-92 and/or UB-04

*May 23, 2007 CCHP will accept only the new UB-04

If you have any questions, please call Provider Relations at (541) 385-5315 or (888) 863-3637.

Links to new forms:

CMS-1500
http://www.cms.hhs.gov/cmsforms/downloads/CMS1500805.pdf

UB-04
http://www.cms.hhs.gov/Transmittals/downloads/R1104CP.pdf

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