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TPA CLAIM FORM 14590 Rev. 1007 Cardholder ID No. Section 1 Plan Participant Cardholder Name Information Section 1 must be fully completed to ensure proper reimbursement Group No./Group Name Address

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How to fill out api-071 nhic claim

01

Gather all relevant information needed to fill out the API-071 NHIC claim form, such as patient details, healthcare provider information, and medical procedures performed.

02

Start by filling out the patient's personal information section, including their full name, address, contact information, and date of birth.

03

Provide the patient's NHIC claim number and relevant NHIC details, such as the effective date of coverage and any additional coverage information.

04

Complete the healthcare provider information section, including the name, address, and contact details of the provider who performed the medical services.

05

Specify the services rendered by providing detailed descriptions of the medical procedures, diagnostic tests, or treatments performed. Include dates of service and any relevant procedure codes.

06

Provide information about the total charges incurred for the services rendered, including itemized costs if applicable.

07

Indicate any payments already made towards the services, including insurance coverage and patient contributions.

08

Sign and date the claim form, ensuring that all the provided information is accurate and complete.

09

Make a copy of the completed API-071 NHIC claim form for your records before submitting it to the appropriate NHIC claim processing authority.

10

Follow up with the NHIC claim processing authority to ensure timely processing and reimbursement.

Who needs api-071 nhic claim?

01

Any individual who is covered by NHIC (National Health Insurance Corporation) and has received medical services can make use of the API-071 NHIC claim form.

02

This includes NHIC insured individuals who have undergone medical procedures, received diagnosis or treatment, or received prescription drugs.

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