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Get Homelink Fax Form
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Open form follow the instructions
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How to fill out the Homelink Fax Form online
Completing the Homelink Fax Form online can streamline the process of submitting important patient information. This guide will walk you through each section and field of the form to ensure you provide all necessary details accurately.
Follow the steps to complete the Homelink Fax Form.
- Click the ‘Get Form’ button to obtain the form and open it for editing.
- Start by entering the ‘Today’s Date’ and ‘Time’ at the top of the form, making sure to mark if the information has been delivered.
- In the ‘Patient Information’ section, fill out the insured name, date of birth, social security number, and patient name. Specify the patient’s relationship to the insured and select their gender.
- Provide the patient’s address, including street, city, state, and zip code, along with their phone number and any alternative contact number.
- Indicate the diagnosis along with the required CPT code. Specify if the patient was injured due to an accident and provide details if applicable.
- Complete the ‘Ordering Physician Information’ section by entering the physician's first and last name, address, phone number, fax number, and NPI number. Also provide the primary care physician's contact information.
- In the ‘DME Request & Provider Information’ area, fill in the date(s) of service, select the side (right, left, or bilateral), and include the procedure codes along with their respective quantities. Provide the provider's information and contact details.
- Lastly, in the ‘Insurance Information’ section, enter the insurance company name, benefits phone number, claims mailing address, policy number, group number, and the employer of the insured. If you have multiple codes, make sure to attach a second sheet with additional codes.
- Once all fields are completed, you can save the form, download it, print it for faxing, or share it as needed.
Complete your Homelink Fax Form online today for a seamless submission process.
VGM Group, Inc. is owned by Van G. Miller, who founded the company to support providers of healthcare products and services. VGM has grown into a comprehensive resource for home medical equipment businesses and related services. Their focus on community support and education aligns well with tools like the Homelink Fax Form, which can streamline documentation processes for providers across the industry.
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