Get the nucc org 1500 claim form 2012-2018

Description of cms 1500 pdf
PLEASE PRINT OR TYPE APPROVED OMB-0938-1197 FORM 1500 02-12 CARRIER HEALTH INSURANCE CLAIM FORM APPROVED BY NATIONAL UNIFORM CLAIM COMMITTEE NUCC 02/12 PICA MEDICAID TRICARE ID /DoD GROUP HEALTH PLAN ID CHAMPVA Medicaid Member ID FECA BLK LUNG 3. PATIENT S BIRTH DATE DD YY MM 2. PATIENT S NAME Last Name First Name Middle Initial F 6. PATIENT RELATIONSHIP TO INSURED Self CITY STATE ZIP CODE 4. INSURED S NAME Last...
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