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Finance 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 Forms
Last Updated: 6/30/2010
Finance FAQ's
Date Posted: 6/30/2010
Active Service List by Service Category
Date Posted: 4/2/2010
PBH Reason Codes
Date Posted: 1/19/2010
Electronic Funds Transfer Form
Date Posted: 11/18/2009
CMS1500 Instructions/Cheat Sheet
Date Posted: 9/28/2009
UB04 Billing Instructions/Cheat Sheet
Date Posted: 9/17/2009
PBH Claim Adjustment Request Form
Date Posted: 6/17/2009
Claim Adjustment/Inquiry Form Instructions
Date Posted: 1/29/2009
Place of Service Crosswalk
Date Posted: 10/13/2008
Provider Claim Inquiry Form
Date Posted: 10/2/2008
Provider Refund Detail Form
Date Posted: 9/18/2008
PBH Health Insurance Info Form
Date Posted: 7/23/2008
