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CODE DMS-694 Rev. 10-99 BILLING DATE 27 OR UNITS TOS PERFORMING FOR OFFICE USE 28 TOTAL CHARGES COVERED BY INSURANCE PROVIDER S SIGNATURE CHARGES BALANCE DUE Instructions for Completion of the EPSDT Claim Form DMS-694 EDS offers providers several options for electronic billing. To bill for a Child Health Services EPSDT screening service use the claim form DMS-694. The numbered items correspond to numbered fields on the claim form. The DMS-694 is...
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What is form dms 694?
Form DMS 694 is a document used for reporting certain financial information to the relevant authority.
Who is required to file form dms 694?
Entities meeting certain criteria determined by the authority are required to file form DMS 694.
How to fill out form dms 694?
Form DMS 694 can be filled out electronically or manually as per the instructions provided by the authority.
What is the purpose of form dms 694?
The purpose of form DMS 694 is to collect financial information for regulatory or compliance purposes.
What information must be reported on form dms 694?
Form DMS 694 requires reporting of specific financial data as specified by the authority.
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