Please read the following message from the HCA:
Claim attachment cover sheets updated
To simplify your claim processes, we reduced the number of claim attachment cover sheets from five to two.
We have replaced the following four cover sheets:
- Electronic claim backup (ECB) attachments
- UB-04 attachments (when supporting documents are detached from original claim)
- CMS-1500 attachments (when supporting documents are detached from original claim)
- ADA 2006 dental attachments
With a single-use form:
Use this form when sending all supporting documents to a non-pharmacy claim.
Has the pharmacy claim attachment changed?
No. There is no change to the pharmacy claim attachment.
Where do I find these cover sheets?
All cover sheets are available on our Document submission cover sheets webpage.