Fillable instructions filling out 1500 form

Description
When more than one supplier is used a separate Form CMS-1500 shall be used to bill for each supplier. Effective for claims received on or after April 1 2004 on the Form CMS-1500 only one name address and ZIP Code may be entered in the block. Attachment - Business Requirements Pub. 100-04 SUBJECT Medicare Fee for Service Legacy Provider IDs Prohibited on Form CMS-1500 and Form I. When applicable show HCPCS code ...
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instructions filling out 1500 form