Get the free Extended Care Claim Form - Student Health Services SIU
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Student Medical Insurance Plan Claim Form Return completed form to: Student Health Center Student Medical Insurance Office 374 E. Grand Ave. Mail Code 6740 Carbondale, IL 62901 P: 618-453-4413 F:
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What is extended care claim form?
Extended care claim form is a form used to request reimbursement for extended care services, such as nursing care or physical therapy, provided to a patient.
Who is required to file extended care claim form?
The healthcare provider who rendered the extended care services is required to file the extended care claim form.
How to fill out extended care claim form?
The extended care claim form should be completed with details of the services provided, patient information, provider information, and any other relevant details.
What is the purpose of extended care claim form?
The purpose of the extended care claim form is to request reimbursement for extended care services provided to a patient.
What information must be reported on extended care claim form?
The extended care claim form must include details of the services provided, patient information, provider information, dates of service, and any relevant documentation.
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