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Get 2017 Claim Forms
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How to fill out the 2017 Claim Forms online
Navigating the 2017 Claim Forms can seem daunting, but this guide provides clear, step-by-step instructions to assist users in completing the form online efficiently. By following these instructions, users can ensure that all necessary information is submitted accurately.
Follow the steps to complete the 2017 Claim Forms online.
- Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
- Select the family planning program you are applying for by checking the appropriate box. Options include DFPP only, Partial Pay, DSHS Family Planning Program (DFPP), or No Pay.
- Enter the provider's name as it appears in the TMHP records in the 'Provider Name' field.
- Input the billing provider's nine-digit TPI in 'Billing Provider TPI' and their NPI in 'Billing Provider NPI'.
- Fill in the 'Eligibility Date' using the format MM/DD/CCYY for the date the client was designated eligible for DFPP services.
- Provide the client's full name in the 'Patient's Name' field, ensuring it matches the records (Last Name, First Name, Middle Initial).
- Complete the address information where the client resides, including street, city, and state, along with the ZIP code.
- Indicate the client's date of birth in the format MM/DD/CCYY and specify their gender by checking the appropriate box.
- Mark the patient's status as either new or established patient.
- Enter the patient's Social Security number, ensuring accuracy, and include the race and ethnicity codes as applicable.
- Fill in the marital status, family income, family size, history of pregnancies, and live births as required.
- Specify the primary birth control method before the initial visit in the appropriate section.
- If applicable, indicate whether there is other insurance available by checking the corresponding box.
- Complete fields related to diagnosis codes, services rendered, and provider information.
- At the conclusion of filling out the form, ensure all information is complete and accurate before saving your changes, downloading, printing, or sharing the completed form.
Start completing your 2017 Claim Forms online today to ensure timely processing of your claims.
To report IRA contributions for a previous year, you'll fill out IRS form 8606 if the contributions were nondeductible. Attach this form to your annual tax return for the year in question, ensuring correctness in reporting. It can be helpful to reference your documentation and use the features of 2017 Claim Forms to maintain clarity on your contributions.
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