Fillable home health medicare secondary payer questionnaire form

Description
MEDICARE SECONDARY PAYOR MSP QUESTIONNAIRE Patient Name Integrated SMPT Acct Medicare exactly as on Red-White-Blue Government Medicare Card Please read and respond to each of the following 1. Have you received Home Health Care of any kind in the past 60 days Yes or NO If yes please provide the name and phone number of the Home Health Agency Home Health Agency Name 2. Do you have any benefits through TriCare...
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