Get the free 2013 primary care provider wellness visit verification form

This form is used to verify a patient's wellness visit for the $50 wellness incentive credit and requires completion by both the healthcare provider and the employee.

How to fill out 2013 primary care provider wellness visit verification form

How to fill out 2013 primary care provider wellness visit verification form

1. Obtain the 2013 primary care provider wellness visit verification form from your healthcare provider's office or website.
2. Fill out your personal information at the top of the form, including your full name, date of birth, and insurance details.
3. Provide the date of your last wellness visit, if applicable.
4. Indicate the reasons for your visit in the designated section, such as routine check-up or specific health concerns.
5. Complete any health history questions that require information about your medical background, allergies, and current medications.
6. Review the form for accuracy and completeness.
7. Sign and date the form at the bottom.
8. Submit the completed form to your primary care provider's office as instructed.

Who needs 2013 primary care provider wellness visit verification form?

1. Individuals seeking to confirm their eligibility for coverage of wellness visits through their health insurance plan.
2. Patients who have recently had or plan to schedule a wellness visit with their primary care provider.

People Also Ask about

How often can you bill G0439?

Description, Billing Rules, and Use Cases. HCPCS G0439 is used to bill a subsequent Annual Wellness Visit (AWV) for Medicare Part B beneficiaries. It may be performed once per calendar year, starting 12 months after the initial AWV (G0438) or a previous G0439 service.

How to code a wellness visit?

CPT code G0438 description Initial Annual Wellness Visits (G0438): Similar to an Initial Preventive Physical Examination, except it is available to a patient after 11 months of Medicare enrollment. This is for patients that miss their window for an Initial Preventive Physical Examination.

What is the ICD 10 code for annual wellness visit?

BILLING AND CODING No specific diagnosis is required for the Annual Wellness Visit, but Z00. 00 or Z00. 01 is appropriate for the Annual Routine Physical Exam.

What is the difference between G0438 and G0439?

HCPCS G0439 is used to code all subsequent Medicare annual wellness visits that occur after the initial AWV (G0438). So, if used correctly, G0439 would not be used until G0402 was used to code the IPPE and G0438 was used to code the initial AWV.

For pdfFiller’s FAQs

What is 2013 primary care provider wellness visit verification form?

The 2013 primary care provider wellness visit verification form is a document used to verify that patients have received a wellness visit from their primary care provider, as part of preventive health services covered by certain health plans.

Who is required to file 2013 primary care provider wellness visit verification form?

Healthcare providers who conduct wellness visits for patients, as part of the requirements of specific health insurance plans or government programs, are required to file the 2013 primary care provider wellness visit verification form.

How to fill out 2013 primary care provider wellness visit verification form?

To fill out the form, providers typically need to include patient demographic information, details of the wellness visit, the date of service, and any relevant observations from the visit as specified in the form guidelines.

What is the purpose of 2013 primary care provider wellness visit verification form?

The purpose of the form is to ensure that health insurance providers can confirm that patients have undertaken their wellness checks and to facilitate the proper billing and reimbursement process for these preventive services.

What information must be reported on 2013 primary care provider wellness visit verification form?

Reported information must include the patient's basic details (name, date of birth), specifics of the wellness visit (date, type of services provided), and the primary care provider's information.