Fillable Tips for Completing the CMS-1500 Claim Form - ValueOptions
Physician s/supplier s billing name address zip code and phone 24j Enter the total charge for this claim. This is the total of all charges for each service noted in Field services billed on this claim. any amount entered in Field 29. NOTE The person rendering care must sign and indicate licensure level. rendered. Not Form CMS-1500 08-05 as early as October 1 2006. Not Applicable Enter the appropriate billing ...
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