claim form


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claim form

(klām fōrm)
Document that gives necessary information about patient, treating provider, and coded treatment, including charges; filed for payment of benefits by carrier of dental insurance.
[L. forma, shape, contour]
References in periodicals archive ?
"If affected product holders have concerns about the way their card security product was sold to them, they should complete and return the original "AI Scheme" compensation claim form received in the post to claim their money back.
"With Claim Forms being sent out in March, that only leaves around two months for farmers to complete and submit them before May 15.
She said: "In this case, due to all of the bank holidays over the Christmas period, that meant the 10 working days from receipt of the claim form was January 4.
"Using the example of a company that has retail operations, this could mean that the claim form may be served at any retail outlet or branch office within England and Wales," said Ms Beaton.
You can't use these codes on a regular ADA dental claim form. You have to use the CMS-1500 form.
After receiving feedback from all branches of the service and from many retired veterans, Combat-Related Special, the organization that handles claims, has revised its claim form. The new form makes it easier to understand who is eligible for CRSC, and specifies what information veterans should provide in order to receive compensation.
Once you have completed the forms, keep a copy for your records and mail the claim to the address indicated on the claim form. You may direct other complaints and comments to the TSA Contact Center at 866-289-9673, or
Q: Can we bill a glucose charge on the same claim form as therapy and prosthetics, or does the glucose need to be on a separate claim?
Like Connecticut and New York, Texas has guides that tell providers exactly which claim form fields they must fill out.
Employees taking leave for one of the above specified reasons can apply for the program by completing an EDD claim form. The forms were scheduled to be available April 2004.