New York Codes, Rules and Regulations
Title 11 - INSURANCE
Appendices
Appendix 18-C

STANDARD CLAIM FORM FOR PHYSICIAN SERVICES

(cf. Part 17)

The Standard Claim Form for Physician Services, which is the HCFA 1500 (New York State), is designed for use by physicians treating patients who may be eligible for benefits from many different sources; however, in conformance with law, the applicability of this standard claim form is limited to use where the patient is entitled to benefits from a commercial insurance company or article IX-C corporation.

Accordingly, any reference in the standard claim form to payors other than commercial insurers and article IX-C corporations should be considered as part of the implementation of chapter 545 of the Laws of 1977 and chapter 11 of the Laws of 1981, but such references are retained in the claim form to permit the use of a form adapted to multi-payor use.

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