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The following forms are designed for home health and hospice providers who submit claims to CGS. All forms are in the Portable Document Format (pdf). If you do not have Adobe Reader software, you can download External Website it at no cost.

Instructions: Type directly into the required fields electronically, then print (and sign, if required). Illegible forms may cause a delay in processing.

Forms are organized by the following topics:


Beneficiary 2nd level screening/BIU


Customer Service

Overpayment & Refunds

Medical Review


Updated: 11.25.19

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