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Enrollment application & change of information Formosa use only Group numberSubscriber numberSynergy Plan and Dual Dental expedite your application, please print legibly in black or blue ink and return
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To fill out Synergy Medical - Dual form, follow these steps:
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What is synergy medical - dual?
Synergy Medical - Dual is a form required to be filed by healthcare professionals who are eligible for Medicare and Medicaid reimbursement.
Who is required to file synergy medical - dual?
Healthcare professionals who are eligible for Medicare and Medicaid reimbursement are required to file synergy medical - dual.
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Synergy Medical - Dual can be filled out electronically through the CMS website or by using the paper form provided by CMS.
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The purpose of synergy medical - dual is to ensure that healthcare professionals are receiving their rightful reimbursements from Medicare and Medicaid.
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Information such as patient demographics, services provided, and billing codes must be reported on synergy medical - dual.
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