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CMS-1450 (UB-04) Claim Forms for Hospitals
All hospitals that participate with Regence BlueCross
BlueShield of Oregon are required to
submit most CMS-1450 (UB-04) claims electronically.
CMS-1500-12/90 Claim Forms for Professional
Services
Regence requires claims to be
submitted electronically or on an original standard CMS-1500-12/90
claim form for professional services. The mailing address for filing claims can vary by product.
Check the back of your member’s identification card for
the correct claims mailing address.
ADA Claim Forms for Dental Services
Regence requires dental claims
to be submitted electronically or by using the current American
Dental Association (ADA) standard claim form.
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