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Medicare Secondary Mayor Questionnaire Part I 1 2 3 4Are you receiving Black Lung (BL) Benefits? Yes, If yes date benefit began / / No BL is primary only for claims related to Black Lung Are the services
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To fill out the 'yes if yes' date, follow these steps:
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Look for the question that asks if the answer is 'yes'.
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If the answer is 'yes', locate the corresponding question for the date.
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Anyone who is required to provide additional information when the answer to a specific question is 'yes' needs to fill out the 'yes if yes' date.
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This date is usually requested by government agencies, legal authorities, or employers to gather more details related to a positive response.
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