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MAXIMUS FEDERAL SERVICES, INC. Independent Bill Review P.O. Box 138006 Sacramento, CA 958138006 Fax: (916) 6054280INDEPENDENT BILLING REVIEW FINAL DETERMINATION June 17, 2015IBR Case Number: Claim
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99215-17 amp wc004-17 refers to a specific form or document used for reporting certain information related to medical services.
Healthcare providers or facilities who have provided medical services and are required to report specific information may be required to file 99215-17 amp wc004-17.
To fill out 99215-17 amp wc004-17, you need to provide the requested information in the designated fields or sections of the form following the instructions provided.
The purpose of 99215-17 amp wc004-17 is to collect and report information related to medical services provided for administrative or regulatory purposes.
The specific information that must be reported on 99215-17 amp wc004-17 may include details about the medical services provided, the healthcare provider, the patient, and any relevant billing or coding information.
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