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LESSON 24 MEDICAL CLAIMS AND BILLING SPECIALIST PART 2ORIGINAL CLAIM FORM FOR ROCKY SANCHEZ 1500 MEDICARE 600 GRANT ST STE 600 DENVER CO 80203 HEALTH INSURANCE CLAIM FORM APPROVED BY NATIONAL UNIFORM
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1927 INSUREDS NPI SSN YOURTOWN FECA DUNCAN SANCHEZ YY DIAGNOSI EPSDT 1010XX 2ORIGINAL 17a MODIFIER RESUBMISSION a-d 24E 17b LMP EMG CHAMPUS TRICARE STE 0201403LB35B-24-39 CHAMPVA EIN 10d 325001926A HCPCS BLK

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