Healthy Pets Claim Form – Fill Online, Printable, Fillable, Blank

Instructions and Help about petfirst healthcare claim shape

Hello this is Joe Moore and I thought I would give you some instructions on how to properly complete a CMS claim form first gear thing you want to remember is that everything has to be in caps and besides you ca n’t use can not use any abbreviations when you complete a title form so we ‘ll start with obstruct 1 and you ‘ll notice that you need to place an ten in one of these blocks to indicate the type of indemnity that you have thus if you have Medicare or Medicaid or TRICARE or Chapa or group plan or fika or other you would mark an ten in the allow slot in 1a you ‘re going to demarcate the patient ‘s ID number for their insurance this number has to have no dashes and no spaces indeed even if the card presents that way you are to type it in with no spaces and no dashes they have a group health number we put the group health number over here farther on the argumentation so you ‘d space polish and place it over here to the far right of the lineage then going to come over here to block 2 and you ‘re going to complete the patient ‘s name so you ‘re going to type in the affected role ‘s stopping point appoint comma space first name comma space and then the center initial if they have a junior attached to their name you would type in Smith space Junior comma space John comma space a for example if they ‘re a doctor or have a title with their list we do not include that on the claim form underneath that then in the next block you ‘re going to enter in the patient ‘s mailing address again we do not use abbreviations indeed if it ‘s Avenue Road Street any of that you ‘re going to type that out completely put in their City and their two two-digit country on F alphabet put in the slide fastener code this is one of the alone places you can put in a dash sol if they have the elongated four finger zip up code you ‘ll fair add in the first five digits comma and then the adjacent four digits for their earphone issue you can see there ‘s already a parentheses to put in the area code and then when you type in their phone number you type it as one long seven finger number you do not put in a stat a crash or a space lease ‘s go improving here to block three up here going to put in the patient ‘s a go steady of birth and you can see that you need to have month month sidereal day day and they write century century year year so you need eight digits you besides need to put an ten in either the male or the female box underneath it of lock six you ‘re going to take shriek type in the relationship of the affected role to the insured so if it ‘s self or their spouse or their child or other other indicates either a domestic partnership or you could besides ensure your parents so you would stick in the other in that box and then you have the affected role status whether they ‘re single or married or other again the early is if they ‘re a domestic partnership you ‘ll want to put that in then I mean underneath that we have whether they are employed a full-time student or a half-time scholar so a lot of insurance companies will ensure your child till their 4:25 if they are full-time students and now filling out parry ten …

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Category : Healthy