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Billing and Claims

Effective January 1st 2019, all ScreenWise providers will need to use the new form formats for all patients being newly enrolled or those being re-enrolled. For patients that were enrolled prior to January 1st 2019, providers will need to have their results and abnormal follow up recorded on the old/existing forms.

OLD Form cut off dates / NEW form implementation:

  • Monday, December 31st: last day to enroll using the old Intake Packet forms
  • Tuesday, January 1st: new forms go LIVE, all new enrollments must be completed using new forms on and after January 1, 2019
  • Monday, April 1st: all result and abnormal follow-up forms need to be submitted on new forms regardless of enrollment date

ScreenWise will be conducting training webinars on the new forms throughout the month of December. These webinars will all be identical but held at 7 different days and times to provide increased access. Please register for webinars here*. Audio/Video form tutorials are available on the ScreenWise Website​.



Claim Forms

ScreenWise Claim Forms are optional tools for billing ScreenWise Program services. These forms are not required and providers are encouraged to submit claims in the manner that best works for their clinic.

Covered Procedures

Reimbursement schedule includes all CPT and ICD-10 diagnosis codes accepted by the program.

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