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Updated claim form - CMS-1500
 

The CMS-1500 has been revised to include the NPI.  Regence began accepting the revised CMS 1500 on January 1, 2007.

Example of the updated CMS-1500 form:

Example of the updated CMS-1500 form:

Note: Be certain to indicate only the provider rendering service in boxes 24 I & J. Indicate only the billing provider in boxes 33 a & b.

 

 

 

 
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