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Revision HCFA-PM-86-20 BERC SEPTEMBER 1986 ATTACHMENT 3. 1-A Page 7 State/Territory Georgia AMOUNT DURATION AND SCOPE OF MEDICAL AND REMEDIAL CARE AND SERVICES PROVIDED TO THE CATEGORICALLY NEEDY 15. Hospice care in accordance with section 1905 o of the Act. I X Provided in accordance with section 2302 of the Affordable Care Act Description provided on attachment TNNo. Supercedes 13-008 Approval Date 06-015 1-3-13 Effective Date 4/1/13 BERQ Page 6 Georgia TO THE MEDICALLY NEEDY c....
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How to fill out hcfa-pm-86-20
How to fill out hcfa-pm-86-20:
01
Start by obtaining the hcfa-pm-86-20 form. You can typically find it at your healthcare provider's office or download it online.
02
Begin filling out the patient's information section. Include their full name, date of birth, address, and contact information.
03
Next, provide the patient's insurance details. This typically includes their insurance company's name, policy number, and any group or member identification numbers.
04
Proceed to the medical service information section. Here, you will need to fill out the appropriate diagnosis and procedure codes for the services the patient received.
05
If applicable, include any supporting documentation or notes related to the medical services rendered. This could include medical records, test results, or referral letters.
06
In the final section, indicate any other important information related to the claim, such as whether it is a primary or secondary insurance claim.
07
Review the filled-out hcfa-pm-86-20 form for accuracy and completeness before submitting it. Ensure all required fields are properly filled, signatures are obtained if necessary, and any supporting documentation is attached.
08
Keep a copy of the completed form for your records before sending it to the appropriate recipient, such as the insurance company or healthcare provider.
Who needs hcfa-pm-86-20:
01
Medical practitioners: Providers who offer healthcare services and need to submit insurance claims for reimbursement utilize the hcfa-pm-86-20 form. This includes physicians, hospitals, clinics, and other healthcare facilities.
02
Patients: Those who have received medical services from a healthcare provider may need the hcfa-pm-86-20 form to provide their insurance information and support the processing of their claims.
03
Insurance companies: The hcfa-pm-86-20 form is essential for insurance companies to process and evaluate claims submitted by healthcare providers and determine the coverage and reimbursement amounts to be provided.
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What is hcfa-pm-86-20?
hcfa-pm-86-20 is a form used for submitting Medicare claims for reimbursement.
Who is required to file hcfa-pm-86-20?
Healthcare providers and facilities that provide services covered by Medicare are required to file hcfa-pm-86-20.
How to fill out hcfa-pm-86-20?
hcfa-pm-86-20 can be filled out manually or electronically, following the specific instructions provided by the Centers for Medicare & Medicaid Services (CMS).
What is the purpose of hcfa-pm-86-20?
The purpose of hcfa-pm-86-20 is to request reimbursement from Medicare for covered services provided to eligible beneficiaries.
What information must be reported on hcfa-pm-86-20?
hcfa-pm-86-20 requires information such as patient demographics, diagnosis codes, procedure codes, and provider information.
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