Get the free Please use this form in lieu of attaching the Medicare Explanation of Benefits (EOMB...
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Dpw. state. pa.us/publications/forproviders/QuickTips/P039243 REQUIRED FOR FQHC AND RHC PROVIDERS/FOR ALL OTHER PROVIDERS MUST IF APPLICABLE. Using your Medicare EOMB please indicate the amount Medicare applied to the yearly Medicare Part B deductible. CMS-1500 MEDICARE ATTACHMENT Please use this form in lieu of attaching the Medicare Explanation of Benefits EOMB when billing Medical Assistance MA for Medicare Deductible and/or Coinsurance. MUST IF APPLICABLE Medicare Coinsurance/Copayment -...
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