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WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES Burial Billing Form INV IB- -- SFY County Sequence 4 digits PART I INFORMATION REGARDING DECEASED WV DHHR County Office Address F.E.I. Item 1 The maximum allowable payment established by the DHHR is 2 450. Item 2 The amount of exempted resource of 1 200. Signature in blue ink Relative s Signature DFA-67-A Rev. 5/15 Date BCF DPVM Use Only Date Doc ID By PART V TO BE COMPLETED BY FUNERAL HOME Line 1. Item 3 The maximum DHHR burial rate of 1...

How to fill out burial billing form

How to fill out a burial billing form:

1. Gather all necessary information: Before starting to fill out the burial billing form, make sure to collect all relevant details such as the deceased person's name, address, social security number, date of birth, date of death, and any insurance information if applicable.
2. Complete the deceased person's information: Begin by entering the deceased person's full name, date of birth, and social security number in the designated fields on the form.
3. Provide the burial or funeral service details: Fill in the date and location of the burial or funeral service in the corresponding sections of the form. Include any additional information regarding the type of service, such as a traditional burial, cremation, or specific requests made by the deceased or their family.
4. Insurance details: If the deceased had any burial or funeral insurance, provide the policy number, name of the insurance company, and any contact information for the insurance provider. This information will be important for potential reimbursement or coverage of expenses.
5. Include itemized expenses: The burial billing form typically requires an itemized breakdown of all expenses related to the burial or funeral service. This may include charges for the casket, embalming, cemetery plot, grave marker, transportation, flowers, clergy fees, and any other associated costs. Provide accurate information for each expense to help calculate the total amount due.
6. Specify the responsible party: Indicate who will be responsible for paying the expenses on the burial billing form. This could be a family member, the executor of the deceased's estate, or someone designated by the family. Include their name, address, and contact information.

Who needs a burial billing form?

1. Funeral homes: Funeral homes typically require a burial billing form to document and account for all expenses incurred during the burial or funeral process. This form helps maintain transparent financial records and ensures that proper billing and reimbursement can take place.
2. Families of the deceased: The family of the deceased also needs a burial billing form to have a clear understanding of all the costs associated with the burial or funeral service. It helps them keep track of expenses, make informed financial decisions, and potentially seek reimbursement from insurance providers or assistance programs.
3. Insurance companies: Insurance companies may request a burial billing form to assess and verify the expenses claimed for reimbursement. This form provides the necessary documentation for insurance companies to determine coverage and facilitate the reimbursement process, if applicable.

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What is burial billing form?

The burial billing form is a document used to report and record expenses related to a burial or funeral service.

Who is required to file burial billing form?

The funeral home or individual responsible for making burial arrangements is required to file the burial billing form.

How to fill out burial billing form?

To fill out the burial billing form, you will need to provide detailed information about the expenses incurred during the burial or funeral service.

What is the purpose of burial billing form?

The purpose of the burial billing form is to keep a record of all expenses related to the burial or funeral service for accounting and reimbursement purposes.

What information must be reported on burial billing form?

The burial billing form must include details of all expenses incurred, such as casket cost, transportation fees, cemetery fees, and any other related costs.