Various Fillable Forms
DENVER HEALTH MEDICAL PLAN, INC. 1500 Claims Processing Manual DHMP Health Insurance Claim Form CMS-1500 Box 1 Medicare, Medicaid, Group Health Plan or other insurance Information Show the type of health insurance coverage applicable to this claim by checking the appropriate box. When DHMP (Group Health Plan) Box 1a Insured's ID Number Enter the patient's DHMP Health Insurance ID Number This is a required field Box 2 Patient's Name (Last Name, First Name, Middle Initial) Enter the patient's last name, first name, and middle initial, if any, as shown on the patient's DHMP card Morealong with the claim form. Box 11a –Insured's Date of Birth. Enter the insured's 8- digit birth date (MM | DD | CCYY) and sex if different from Box 3 ... Less
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