Username

Password

Claim Form Information

Find

Not Registered Yet?

Join Our Network

GHP Clinical Policies

Claims & E-transactions

Forms & Resources

GHP Family

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.

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.


Who to Call

Important contacts for providers: