Get the free texmed connect compass 21 claim form 2017
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2017 Claim Form 1. Choose one 1a. DFPP only Family Planning Program XIX PHC DSHS Family Planning Program DFPP No Pay 3. Provider Name 2b. Billing provider NPI 4. Eligibility Date MM/DD/CCYY 6. Patient s Name Last Name First Name Middle Initial 8. County of Residence 9. Date of Birth 10. Sex White 1 Asian 5 Black 2 Unk/Not Rep 6 5. DSHS Client No* Medicaid PCN if XIX 7. Address Street City State MM/DD/CCYY 13. Race Code 2a* Billing Provider TPI Partial Pay F 7a* ZIP Code 11. Patient Status M...
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What is texmed connect compass 21?
texmed connect compass 21 is a reporting tool used in the healthcare industry.
Who is required to file texmed connect compass 21?
Healthcare providers are required to file texmed connect compass 21.
How to fill out texmed connect compass 21?
texmed connect compass 21 can be filled out online through the texmed connect platform.
What is the purpose of texmed connect compass 21?
The purpose of texmed connect compass 21 is to collect and report healthcare data.
What information must be reported on texmed connect compass 21?
Specific information required to be reported on texmed connect compass 21 includes patient demographics, medical procedures, and billing information.
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