Get the free ForwardHealth Claim Form Attachment Cover Page, F13470. ForwardHealth Claim Form Att...

DEPARTMENT OF HEALTH SERVICES Division of Medicaid Services F13470 (10/2008)STATE OF WISCONSIN DHS 106.03(1), Wis. Admin. CodeFORWARDHEALTHCLAIM FORM ATTACHMENT COVER PAGE Instructions: Type or print

How to fill out forwardhealth claim form attachment

How to fill out forwardhealth claim form attachment

1. To fill out the ForwardHealth claim form attachment, follow these steps:
2. Start by printing the form in legible handwriting or typing the information directly into the form.
3. Begin by filling out the personal information section, which includes your name, address, phone number, and Social Security number.
4. Fill out the insurance information section accurately, including your insurance provider's name, address, and phone number.
5. Provide the necessary details of the policyholder, including their name, policy number, and relationship to the insured person.
6. In the claim details section, include the date of service, the name and address of the provider, and the services received or procedures performed.
7. Ensure that you include the corresponding diagnosis codes for each service or procedure.
8. If applicable, provide any additional information or supporting documents that are required for the claim.
9. Double-check all the entered information for accuracy and completeness.
10. Sign and date the form at the designated space to certify that the information provided is true and correct.
11. Make a copy of the filled form for your records.
12. Submit the completed form and any supporting documents to the appropriate ForwardHealth office or the designated address.
13. It's important to follow the instructions provided by ForwardHealth and consult with your healthcare provider or insurance company if you have any doubts or questions while filling out the form.

Who needs forwardhealth claim form attachment?

1. The ForwardHealth claim form attachment may be required by individuals who are enrolled in the ForwardHealth program and need to submit additional information or documentation along with their claim form. This attachment is typically used in cases where the standard claim form alone does not provide sufficient space for providing all the necessary details or when supporting documents are required to support the claim. It is recommended to consult with ForwardHealth or your healthcare provider to determine if you need to fill out the claim form attachment in your specific situation.

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What is forwardhealth claim form attachment?

The ForwardHealth claim form attachment is a supplementary document that provides additional information and documentation related to healthcare claims submitted to ForwardHealth, ensuring that claims are processed accurately.

Who is required to file forwardhealth claim form attachment?

Providers who submit claims for services rendered to ForwardHealth recipients are required to file the ForwardHealth claim form attachment, especially when additional information is needed to process the claim.

How to fill out forwardhealth claim form attachment?

To fill out the ForwardHealth claim form attachment, providers must complete the required fields with accurate patient and billing information, details of the services rendered, and any necessary codes or supporting documents as specified by ForwardHealth guidelines.

What is the purpose of forwardhealth claim form attachment?

The purpose of the ForwardHealth claim form attachment is to facilitate the provision of necessary details that support the processing and reimbursement of claims, ensuring that all relevant information is available for adjudication.

What information must be reported on forwardhealth claim form attachment?

The information that must be reported includes patient details, service provider information, service codes, dates of service, diagnosis codes, and any relevant documentation that substantiates the claim.