Use this form to obtain required billing information from your patients. The form should be completed in its entirety as the data is mandatory for timely claim payment.  Be sure to include Name, Address, Phone #, Patient and Subscriber Date of Birth and Social Security Number, Insurance Information (including both the patient and subscriber ID #'s), and the mental health phone number located on the back of the insurance card.
 

Use this form to document your daily patient visits. The form should be filled out completely for the entire week, paying particular attention to Patient Name, Date of Service and Procedure Code. Send in the form with your Patient Registrations and EOB's at the end of every week.
 

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Spring 2005 Newsletter
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