These are the Basic Sheets you will use to submit information to Chiropractic Billing Group in order for us to submit your insurance claims. We will customize these forms for your specific office once we have been contracted by you to provide chiropractic billing service for your office.

At that time we will set up a user login account for you where you will have access to your customized office forms.

Sample Commercial or Cash Patient Sheet

The Commercial or Cash Patient Sheet should be used for patients with commercial health insurance, such as BCBS products, Coventry or Humana for example. This sheet is also used for Medicare, Medicaid or Cash patients. Cash patients only need to complete the top portion. Sample Commercial or Cash Patient Sheet

Sample Personal Injury/Worker’s Compensation Patient Sheet

The Personal Injury/Worker’s Compensation Patient Sheet should be filled out according to the type of patient. If you have a Personal Injury patient, you would indicate which type of insurance your are filing for the patient such as Med-Pay, PIP, or Third-Party Liability. You may also use this sheet for Slip & Fall patients or Settlement Case patients that only have an attorney on file without insurance carrier information. Sample Personal Injury/Worker’s Comp Patient Information Sheet

Day Sheet

The Day Sheet is used by chiropractic offices to forward patient services and payment for data entry. Completed Day Sheet(s) are submitted to us daily by your office via fax or uploaded to your file manager folder. Sample Day Sheet