N.Y. Comp. Codes R. & Regs. tit. 11 § 17.1

Current through Register Vol. 46, No. 38, September 18, 2024

Section 17.1 - Establishment of standard claim forms

(a) The Superintendent of Insurance hereby established standard claim forms for the services performed by physicians and dentists in New York State. For the services provided by hospitals in New York State, the Superintendent of Insurance establishes as a standard claim form the uniform inpatient hospital billing form prescribed by the Commissioner of Health in section 405.28 (10 NYCRR Part 405) to be used statewide by all hospitals.

(b) The standard claim form for physician services is the HCFA 1500 (New York State), and is incorporated herein as Appendix 18-C, infra. With the understanding that instructions for this form will be provided to the physician by the various payors to fit their particular claim needs, no claim form instructions are included in Appendix 18-C, infra. With the understanding that instructions for this form will be provided to the physician by the various payors to fit their particular claim needs, no claim form instructions are included in Appendix 18-C, infra. The standard claim form for the services of dentists is the attending dentist's statement approved by the Council of Dental Care Programs of the American Dental Association, 1975, and is incorporated herein as Appendix 18-B, infra. Appendix 18-B, infra does not include claim form instructions.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 17.1