Fill out the second form the cms 1500 form

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Reference no: EM131166115

Fill out the second form the CMS 1500 form.

On how to properly fill it out. I attach two files the first file is the claims worksheet and I have already answered it.

It also have the info that needed to be used to fill out the CMS 1500 form.

On the end of the claims worksheet completed it tells you what numbers or section to fill out on the cms 1500 form.

Attachment:- CMS-1500-Claim-Form-Blank-form.rar

Attachment:- worksheet-claims-worksheet.rar

Reference no: EM131166115

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