HealthChoice Provider Billing Guides
HealthChoice offers a billing guide for the UB-04, CMS 1500, and ADA 2012 Dental Claim Forms to assist you in filing your HealthChoice claims. Each guide contains a view of the form, a legend of codes used, and descriptions of content for each block. If you strictly follow the guidelines, we believe you will experience fewer difficulties with claim payments as well as higher levels of speed and accuracy. Please make sure you are using the most appropriate billing guide for the specific claim form used to submit your claims.
Use the links below to access block-by-block instructions for completion of the claim forms accepted by HealthChoice.
- ADA 2012 Form (pdf, 2 pp, 1.4 MB) Instructions (pdf, 2 pp, 1.02 MB)
- CMS 1500 Form (pdf, 4 pp, 3.7 MB) Instructions (pdf, 1 p, 95 KB)
- UB-04 (pdf, 3 pp, 371 KB)
It is very important to review and fully understand the information provided in this section of the website. Using outdated claim forms and not following the guidelines set in the HealthChoice Billing Guide will result in your claim being returned.