HCR 220 Week 8 Checkpoint Complete a CMS 1500 Claim Form

HCR 220 Week 8 Checkpoint Complete a CMS 1500 Claim Form


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Asked by 8 months ago
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Appendix C

  1. MEDICARE        MEDICAID                TRICARE                CHAMPVA                  GROUP                                 FECA                 OTHER                              1a. INSUREDS I.D. #                         (For Program in Item 1)
    
                                            CHAMPUS                                         HEALTH PLAN                          BLK LUNG
    
    (Medicare #)    (Medicaid #)        q   (Sponsors SSN)        (Member ID #)            (SSN or ID)                          (SSN)                  (ID)                              999000666
    
    
    
    
    
                                                                                                                                                                                ...
    
HCR 220
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H
Answered by 8 months ago
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Oh Snap! This Answer is Locked

HCR 220 Week 8 Checkpoint Complete a CMS 1500 Claim Form

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Excerpt from file: Appendix C TRICARE CHAMPUS (Sponsors SSN) CHAMPVA (Member ID #) 2. PATIENTS NAME (Last Name, First Name, MI) FECA BLK LUNG (SSN) 3. PATIENTS BIRTH DATE MM DD YY Smith Jane 5. PATIENTS ADDRESS ( #, Street) 1111 Noname Court CITY STATE Nowhere NY ZIP CODE GROUP HEALTH PLAN (SSN or ID) OTHER 1a.

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Asked: 8 months ago

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