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Submission Packet Forms

The following forms are neccessary to submit a Clinical Trial through the OCT.

Billing Plan Form
[Download Word Document]
Use this form to develop a comprehensive visit schedule to delineate billable vs. non-billable procedures/services.

Please click on the link then choose "save as" and save to the computer hard drive. This file can then be copied and saved for each specific project within your system.

Billing Plan Quick Instructions for Completion

Quick Instructions are available to help you get started.

Billing Plan Guidance Document
[Download Word Document]

Please click on the link then choose "save as" and save to the computer hard drive.

CPT Code List
[Download Excel Document]
The 2005 Medicare / Research Rate list by CPT code for common tests performed during research projects. If the test or procedure is not listed, please contact the Office of Clinical Trial Operations for assistance. This list will be continually updated.

Please click on the link then choose "save as" and save to the computer hard drive. This file can then be copied and saved for each specific project within your system.

Clinical Trials Financial Feasibility (optional)
[Download Excel Document]

This form can help develop a feasibility assessment for a specific project which encompasses both procedural information as well as staffing/resource utilization information. If you need assistance, please contact our office

Please click on the link then choose "save as" and save to the computer hard drive. This file can then be copied and saved for each specific project within your system.

Additional Required Documentation

These documents must be submitted along with the billing plan form:

  • Protocol
  • Any Templates(ICF, Contract)
  • Investigator's Brochure (if available)
  • Draft ICF (if available)
  • Draft Budget (if available)

A FAQ (Frequently Asked Questions) is also available.
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