Geisinger Health Plan® - Claim Form Information

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Claim Form Information

UB04 and CMS 1500 Forms

Forms are to be submitted with your NPI number only.

Please click below for samples of these claim forms:
UB04
UB04 Instructions
CMS 1500
CMS 1500 Instructions

If you have questions regarding the UB04 or new CMS 1500 forms, please contact your Provider Relations Representative.

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Contacts for Provider
Network Management

If you have questions or need information, please contact your Geisinger Health Plan provider relations representative at
(800) 876-5357.



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