A Health Care Plan that Cares for People First.
Providers

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CMS-1500 Claim Form adobe pdf

UB-92 Claim Formadobe pdf

Dental Claim Form adobe pdf - Use for pretreatment estimates and dental claims

835/Electronic Remittance Set-Up Request adobe pdf

EFT Authorization Request Form adobe pdf

NC Uniform Application to Participate as a Health Care Practitioner adobe pdf

Precertification Request Form adobe pdf

Medication Request Form adobe pdf

Provider Information Change Form adobe pdf