CO MED-9 2014 free printable template

COLORADO DEPARTMENT OF HUMAN SERVICES MED9 FORM The Aid to the Needy Disabled (AND) program provides financial benefits to Colorado residents who are disabled. This form is used by County Departments

How to fill out CO MED-9

How to fill out CO MED-9

1. Gather the necessary documents and information required to complete CO MED-9.
2. Start filling out the personal details section, including your name, address, and contact information.
3. Provide details about your insurance coverage, including the policy number and provider contact information.
4. Fill in the medical information section, detailing the medical condition and any relevant treatments received.
5. Complete the section on authorized representatives, if applicable, by providing their name and contact information.
6. Review the entire form for accuracy and completeness before submission.
7. Sign and date the form to validate your application.

Who needs CO MED-9?

1. Individuals applying for medical assistance or benefits.
2. Patients seeking reimbursement for medical expenses.
3. Healthcare providers filing claims on behalf of patients.
4. Anyone needing to report medical conditions to a relevant authority.

Instructions and Help about CO MED-9

Hello managers in this video I will be showing you how to fill out a nine form please please please make sure that you do it right were going to start with the patient number one well its really page number seven page number seven is the first page which employee the new employee that we hire he fills that out you see it says employer completes the next page this page must be filled by an employee, so I'm going to go through it this is an example last name of employee well go right here first name well go right here middle name well go right here any other names they have use well go right there the address well go right here art my number if any city state zip code and again this is just an example these addresses names are all fake data birth is this is employee social security number this is their email address this is their phone number and being in Mississippi everybody just about as US citizens, so they will check right here citizen of the United States and only thing employee got to do sign it and date it this part down here it's for translator is for someone who doesn't speak English which in our business everybody speaks English and all of them are US citizens, so again only thing employee got to do just fill this thing out mark he's a citizen if he is a citizen then sign it and date it his job is complete that's all he's just going to turn the space to you now were going to move forward with page number eight really page number two which employer Phil sees this employer or authorized represent a review and further verification right here you will this employee last name first name so in his here you put his first name in a last name okay last name and then the first name okay its very clear right there and mostly in Mississippi just about everybody have their driver's license or state-issued identification card and a social security card, so I'm not going to go over the detail the page a which you can if you want to do let me show you real quick what does it say right here lists a documents that establish both identity and employment authorization, so it gives you everything that you need to that employer can present to you but mainly here in Mississippi nobody has passport they mainly have driver's license ardor ID or social security card so the list B of documents it says right here read this carefully employee may present one selection from list a, so lets say if you present you a US passport or any of this document right here Shelton or combination of one selection from B and one selection of C then he is good to go but were going to focus on B and C only because like I said most of the time they only have they have ID, or they have a driver's license, and they have a social security card so on the list B documents you will write down the title driver's license or state ID issuing authority Mississippi what is their number driver's license or ID number expiration date okay, and I'm going to see you will put the Social Security...

What is med 9 form?

The Aid to the Needy Disabled (AND) Program provides financial benefits to Colorado residents who are disabled. This form is used by County Departments of Human Services to determine medical eligibility for the AND Program.

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What is CO MED-9?

CO MED-9 is a specific form or document used for reporting medical-related information or claims in the context of workers' compensation or medical billing.

Who is required to file CO MED-9?

Employers, insurance carriers, or medical providers involved in workers' compensation cases are typically required to file the CO MED-9 form.

How to fill out CO MED-9?

To fill out CO MED-9, follow the guidelines provided, including entering the required information accurately in the designated fields such as patient details, medical services provided, and any claim numbers.

What is the purpose of CO MED-9?

The purpose of CO MED-9 is to facilitate the reporting and processing of medical claims related to workplace injuries, ensuring that all relevant information is captured for reimbursement.

What information must be reported on CO MED-9?

The CO MED-9 form must report information including patient identification, date of service, type of medical procedures performed, diagnosis codes, and any related billing details.