Finance Claim Forms

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Finance Claim Forms for providers. Please click on the links below to access the information you need. Should you have any questions please contact the Finance Department at 704-721-7000

Finance Claim Forms

Last Updated: 7/23/2008

 UB04 Isolated Instructions-Cheat Sheet Revised
    Date Posted: 7/23/2008

 Provider Claim Inquiry Form 40706
    Date Posted: 7/23/2008

 PBH Health Insurance Info Form
    Date Posted: 7/23/2008

 UB04 Claim Form
    Date Posted: 7/23/2008

 Claim Adjustment-Inquiry Instructions-Revised
    Date Posted: 7/23/2008

 CMS1500 Isolated Instructions-Cheat Sheet
    Date Posted: 7/23/2008