Get 150003 Billing Guidelines - Emedny - Emedny

This guide provides clear and supportive instructions for filling out the 150003 Billing Guidelines - EMedNY - Emedny form online. Whether you are a seasoned provider or new to the process, these steps will help ensure accurate and efficient claims submission.

Follow the steps to complete the form correctly.

1. Press the ‘Get Form’ button to access the billing form, ensuring it opens in an editable format for your convenience.
2. Begin with the Header Section. Enter the patient's name in Field 1, followed by their date of birth in Field 2 and check the patient’s sex in Field 5A.
3. Input the patient's Medicaid number in Field 6A, ensuring that it matches the number on their Common Benefit ID Card.
4. Proceed to fill in details about any accident-related conditions in Field 10, marking the appropriate box as necessary.
5. Complete Field 16A by indicating whether the case was an emergency by marking 'Yes' if immediate intervention was required.
6. When applicable, provide the name of any referring physician in Field 19, along with their NPI in Field 19C if involved in the treatment.
7. In the Encounter Section (Fields 24A to 24O), enter the date of service in Field 24A, and describe the type of service provided in Field 24C.
8. Ensure the appropriate diagnosis code is entered in Field 24H and provide the correct charges or approved amounts in Fields 24J, 24K, and 24L.
9. Review all entries for accuracy before proceeding to the Trailer Section where you will complete the certification and provider identification fields.
10. Finally, save changes, then you can download, print, or share the completed form as necessary to submit for processing.

Take action now and complete your forms online to ensure efficient billing and payment processing.