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Advisory 2000-05B

Revised Forms Effective Date

Although TWCC encourages the immediate use of the following revised forms and instruction sheets, the following will be required effective February 1, 2001:

TWCC-60(A|B), Medical Dispute Resolution Request/Response

TWCC-62, Explanation of Benefits

TWCC-67, Instructions for Completing the HCFA-1500

TWCC-68, Instructions for Completing the UB-92

TWCC-48, Request for Travel Reimbursement

These forms and instructions are available on our Web page at and may be downloaded and copied.

Signed this 29 th day of August, 2000

Leonard W. Riley, Executive Director

Distribution:

TWCC Staff
Public Information List
Commission Representatives
Professional Medical Associations