This website uses cookies to ensure you have the best experience. Learn more

Hcr 220 Week 8 Checkpoint Essay

535 words - 3 pages

Appendix C
1. MEDICARE (Medicare #) MEDICAID (Medicaid #) TRICARE CHAMPUS (Sponsor’s SSN) CHAMPVA (Member ID #) GROUP HEALTH PLAN (SSN or ID) FECA BLK LUNG (SSN) OTHER (ID) SEX M 1a. INSURED’S I.D. # (For Program in Item 1)

999000666
4. INSURED’S NAME (Last Name, First Name, MI) F

2. PATIENT’S NAME (Last Name, First Name, MI)

Doe Catherine
5. PATIENT’S ADDRESS ( #, Street)

3. PATIENT’S BIRTH DATE MM DD YY

01

01

1950
Child Other

Doe James
7. INSURED’S ADDRESS ( #, Street)

6. PATIENT RELATIONSHIP TO INSURED Self Spouse 8. PATIENT STATUS Single Employed

CITY

STATE

PH O EN
CITY ZIP CODE

1111 Noname Court
Nowhere
ZIP CODE

NY
TELEPHONE (Include Area Code)

Married Full-Time Student

Other

TELEPHONE (Include Area Code)

22222

(

)

...view middle of the document...

S. Army

c. INSURANCE PLAN NAME OR PROGRAM NAME

d. INSURANCE PLAN NAME OR PROGRAM NAME

10d. LOCAL USE

d. HEALTH BENEFIT PLAN? YES NO

If yes, return to and complete item 9 a-d.

14. DATE OF CURRENT: MM DD YY

ILLNESS (First symptom) OR INJURY (Accident) OR PREGNANCY (LMP)

15. IF PATIENT HAS HAD SAME OR SIMILAR ILLNESS. GIVE FIRST DATE MM DD YY

O

SIGNED

Signature on file

F

READ BACK OF FORM BEFORE COMPLETING & SIGNING THIS FORM. 12. PATIENTS OR AUTHORIZED PERSON’S SIGNATURE

13. INSUREDS OR AUTHORIZED PERSON’S SIGNATURE

DATE

.

SIGNED

Signature on file

FROM

16. DATES PATIENT UNABLE TO WORK IN CURRENT OCCUPATION MM DD YY MM DD YY TO

17. NAME OF REFERRING PROVIDER OR OTHER SOURCE

17a.

19. RESERVED FOR LOCAL USE

TY

17b.

NPI

18. HOSPITALIZATION DATES RELATED TO CURRENT SERVICES MM DD YY MM DD YY FROM TO 20. OUTSIDE LAB? $CHARGES

21. DIAGNOSIS OR NATURE OF ILLNESS OR INJURY 1. | 2. | 24. A. MM

V70.0 .
. .

YES NO 22. MEDICADE RESUBMISSION CODE ORIGINAL REF. # 23. PRIOR AUTHORIZATION #

.

3. |

.

.

SI

4. |

.

. E. DIAGNOSIS POINTER
(1, 2, 3, or 4)

DATE(S) OF SERVICE From To DD YY MM

B.

C.

DD

YY

PLACE OF SERVICE

EMG

D. PROCEDURES, SERVICES, OR SUPPLIES (Explain Unusual Circumstances) CPT/HCPCS MODIFIER

F. $ CHARGES

G.
DAYS OR UNITS

H.
EPSDT Family Plan

I.
ID. QUAL.

ER

1

NPI

NPI

NPI

UN IV

NPI 26. PATIENT’S ACCOUNT # 27. ACCEPT ASSIGNMENT?
(For govt. claims, see back)

25. FEDERAL TAX I.D. #

SSN EIN

28. TOTAL CHARGE $

29. AMOUNT PAID $

YES 32. SERVICE FACILITY LOCATION INFORMATION

NO

31. SIGNATURE OF PHYSICIAN OR SUPPLIER INCLUDING DEGREES OR CREDENTIALS

33. BILLING PROVIDER INFO & PH #

(

SIGNED

DATE

a.

b.

a.

b.

IX
STATE

)

SEX

F

.

J. PROVIDER ID. #

30. BALANCE DUE $

)

Other Papers Like Hcr 220 Week 8 Checkpoint

IT 206 UOP Tutorial / it206dotcom

955 words - 4 pages and DQ 2 IT 206 Week 6 CheckPoint Analyzing Data IT 206 Week 6 Assignment Microsoft Access Exercise IT 206 Week 7 CheckPoint Other Uses for PowerPoint IT 206 Week 7 DQ 1 and DQ 2 IT 206 Week 8 CheckPoint Pitfalls to a Presentation IT 206 Week 8 Assignment Microsoft PowerPoint Exercise IT 206 Week 9 capstone DQ IT 206 Week 9 Final Project Common Microsoft Office Errors ...................................................... IT 206

PSY 240 Tutorials / psy240dotcom Essay

926 words - 4 pages CheckPoint Sexual Orientation and Identity PSY 240 Week 5 DQ 1 and DQ 2 PSY 240 Week 6 CheckPoint Sleeping and Dreaming PSY 240 Week 6 CheckPoint Theories of Sleep PSY 240 Week 6 Assignment Sleep Deprivation, Disorders, and Drugs PSY 240 Week 7 CheckPoint Emotions PSY 240 Week 7 DQ 1 and DQ 2 PSY 240 Week 8 CheckPoint Cerebral Lateralization and Functionality PSY 240 Week 8 Assignment Psychiatric Disorders, Diseases, and Drugs PSY 240 Week 9

Accounting

1776 words - 8 pages ® document. | | | Summary of Week 8 Deliverables |Assignment |Location |Due | |CheckPoint: Direct and Indirect Cash Flows | Assignments link | Wednesday | |Assignment: Exercises

Cjs 240 Entire Course

1614 words - 7 pages presentation. Present the policy or policies that you believe are the best strategies for reducing youth drug use. · Include detailed speaker notes for each slide. · Cite at least two sources in APA format to support your statements. · Post your presentation as an attachment. CJS 240 Week 8 Checkpoint Drug Use and Delinquency Response 1. CheckPoint: Drug Use and Delinquency Response

World Relgion

2032 words - 9 pages are available on your student Web site. Supplemental Resource Axia College’s Writing Style Handbook, available online at https://axiaecampus.phoenix.edu/Writing_Style_Handbook_AxiaUOP.pdf Weekly Point Values Week One CheckPoint: Effects of Religion 30 Assignment: Vocabulary Quiz 70 Week Two Exercise: Indigenous Culture Web Site Reviews 20 Discussion Questions 20 Participation 10 Week Three CheckPoint: Hindu Terms Map 30 Assignment

IT 240 Tutorials / it240dotcom

821 words - 4 pages Checkpoint Vocabulary Table IT 240 Week 6 Assignment Work Group Scenarios IT 240 Week 1 DQ 1 and DQ 2 IT 240 Week 8 Checkpoint Threat Categorization IT 240 Week 8 Assignment Disaster Plan IT 240 Capstone Question IT 240 Final Project LAN Consulting Plan - PLEASE ADD OWN IMAGES ........................................... IT 240 Final Project LAN Consulting Plan Resources: Appendix A, Local Area Networks b. Due Date: Day 7 – Post to

Course Design Guide It/237

3494 words - 14 pages with CSS and Images. Note. The lab is a learning tool to help you complete the CheckPoint. Complete the lab, worth 5 points of the assignment, as instructed. Enhance each of your web pages from Week Four.     Apply cascading style sheets (CSS) to format elements. Integrate image and rule graphics effectively into the site. Add content to each page in your website. Add at least one list to one of your web pages. ® 50 Check all of your HTML

Heeeeeeee

3049 words - 13 pages development of the children in each of the age groups selected in Week Six.            Format your paper according to APA guidelines.          Post your paper as an attachment.   ------------------------------------------------- Weekly Reminders Summary of Week 8 Deliverables Assignment | Location | Due | Checkpoint : Moral Reasoning | Assignment Forum | Thursday Day 4 |  Assignment : Social and Moral Development |  Assignment Forum

Steps in Medical Billing

624 words - 3 pages Steps in Medical Billing HCR/220 6/8/2012 Theresa Rosado The processes of medical billing used in healthcare, providers and insurance companies have to submit and follow ups in order to receive payments from the medical services. Ten steps are used to complete the medial billing process. There are three categories which is visit, claim, and post claim. Visit makes up the first categories that consist of the first four steps. Pre

Xacc280 Appendix D

2537 words - 11 pages , read the policies governing your current class modality. Course Materials Weygandt, J. J., Kimmel, P. D., & Kieso, D. E. (2008). Financial accounting (6th ed.). Hoboken, NJ: Wiley. All electronic materials are available on the student website. |Week One: Basic Accounting Principles and Concepts

Hum/130 Syllabus

1812 words - 8 pages | ------------------------------------------------- ------------------------------------------------- Week Three: Hinduism | | Details | Due | Points | Objectives | 2 3.5 Describe the Hindu philosophical systems and forms of worship. 3.6 Explain the origins of Hinduism. | | | CheckPoint Hindu Terms Map | Post your answers to Appendix E. | 10/25 | 30 | Individual Hinduism Paper | Write a 700- to 1000-word paper answering the following questions: Considering that Hinduism lacks a

Related Essays

Psy/220 Week 3 Checkpoint Essay

531 words - 3 pages Empathy Exercise Gina Krazer PSY/220 December 13, 2011 Mary Jeanell Buck Snap judgments have a negative effect of hindering one’s ability to foster empathy. Often, such judgments can prove to be incorrect about a person, if the time is taken out to get to know him/her. According to Bolt (2004, p. 51), “People are not always what they seem at first glance. This is not to say that negative judgments are always erroneous or that

Psy 210 Psychotherepy Checkpoint Week 8

307 words - 2 pages | | Checkpoint: Psychotherapy Psychotherapy is helping him or her discover their minds nature and inner workings. This is done by processing their three regions of consciousness; the id, the ego, and the super ego. Sigmund Freud developed his theory (psychodynamics) through the process of identifying four characteristics that diagnosed mentally ill patients. This process included dream analysis, association, and transference. Psychologists

Psy 270 Uop Course Tutorials / Uoptutorials

606 words - 3 pages PSY 270 Week 5 Checkpoint Substance Abuse PSY 270 Week 5 DQ 1 and DQ 2 PSY 270 Week 6 Checkpoint Mind Over Matter PSY 270 Week 6 Assignment Schizophrenia Presentation PSY 270 Week 7 Checkpoint Autism and Mental Retardation Appendix F PSY 270 Week 7 DQ 1 and DQ 2 PSY 270 Week 8 Checkpoint DSM-IV Problems Appendix G PSY 270 Week 8 Assignment DSM-IV Evaluation Appendix H PSY 270 Week 9 Capstone DQ PSY 270 Week 9 Final Project Psychological

Xcom 100 Week 7 Checkpoint Infomercial Microsoft Powerpoint

376 words - 2 pages Microsoft® PowerPoint® COM100 / X COM 100 / Week 8 CheckPoint: Mass Communication Paper XCOM100 / X COM 100 / Week 8 Assignment: Advertising in Society Paper XCOM100 / X COM 100 / Capstone Ethics in Communications Paper XCOM100 / X COM 100 / Capstone Discussion Question Are you great at a sport and want to be part of that sport's team at a college, too? Consider making a call to the college and speaking to the coach of the