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Get Keystone First Community Healthchoices (chc) Chckf_18336072
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How to fill out the Keystone First Community HealthChoices (CHC) CHCKF_18336072 online
This guide provides clear and supportive instructions on filling out the Keystone First Community HealthChoices (CHC) CHCKF_18336072 form online. With step-by-step directions, you can complete the form accurately and efficiently.
Follow the steps to successfully complete the form.
- Click the ‘Get Form’ button to access the Keystone First Community HealthChoices (CHC) CHCKF_18336072 form and open it in the digital editor.
- Enter the facility name where the participant was admitted under 'Facility name'. Ensure the name is spelled correctly to avoid confusion.
- Fill in the participant information section by providing the date of admission. Remember to notify Keystone First CHC on the first business day following the date of service.
- Input the participant ID number and date of birth. Double-check these entries for accuracy, as they are crucial for identification.
- In the participant's name field, provide the full legal name of the individual receiving care. Ensure correct spelling for accurate record management.
- Select the type of admission by checking the appropriate box: Inpatient, Medical observation, Short procedure, or Obstetric observation.
- Describe the diagnosis or reason for admission clearly in the provided field. This should accurately reflect the medical needs.
- Enter the name of the attending physician, ensuring it matches the official records to prevent any issues related to care or billing.
- Complete the Keystone First CHC provider ID number, which identifies the healthcare provider associated with this admission.
- If procedures were performed, list them in the specified section, particularly for Short Procedure Unit admissions. This detail is essential for authorization.
- Indicate whether the participant is pregnant by selecting 'Yes' or 'No' and provide the estimated date of confinement if applicable.
- For Keystone First CHC internal use, leave the 'Case number' field blank, as this will be filled by the staff.
- Finally, choose your preferred method of response by indicating either fax or phone, and ensure that the correct number is provided.
- Review all entries for accuracy and completeness. Once satisfied, save changes, and download or print the form as needed.
Complete your form online today to ensure a smooth process!
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You typically have up to 90 days to submit a claim to Keystone First Community HealthChoices (CHC) CHCKF_18336072 from the date of service. It’s crucial to keep track of your submission timeline to ensure your claim is processed without issues. For any specific situations or concerns, you can reach out to their support team for clarification.
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