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Forms - ABN, UB04, CMS 1500, Medicare...
Forms - ABN, UB04, CMS 1500, Medicare...

Forms

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Advance Beneficiary Notice (ABN) - Updated 06/2012

What Doctor's need to know about the ABN (6.9MB - PDF File)

The new ABN form is to be used beginning November 2011. The ABN forms below are the new ones.

English:

ABN form PDF (CMS-R-131) (03/11 - This form is not editable)
ABN form - editable DOC (03/11)
ABN form Instructions (updated 04/2012)

Spanish

ABN form PDF (CMS-R-131) (03/11 - This form is not editable)
ABN form - editable DOCX  (03/11 - Please note that this is a DOCX file and not a DOC file type)


Non-Facilities (Providers) - CMS-1500 helps:

Place of Service Codes

Facilities- UB-04 (formerly the UB-92) helps:

Download the UB-04 (CMS-1450) Medicare Claims Processing Manual Updated 7/08
Condition Codes Table
Place of Service Codes (476K - PDF File)
Revenue Codes
UB-04 Form


Medicare
For claims processing manuals, see the appropriate form above (CMS 1500 or the UB04)

Medicare Directory of Contractors (Carriers) - available to Behavioral Health MultiBook current customers.  Click here to access the subscriber pages.

Part D:  Exceptions Request for non-formulary drugs (140K - PDF File)

 


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