Get World Trade Center Health Program - Pba Health

This guide provides a comprehensive overview of how to effectively complete the WORLD TRADE CENTER HEALTH PROGRAM - PBA Health form online. It aims to support users with step-by-step instructions tailored to meet their needs.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred online environment.
2. Begin filling out the form by entering the date in the designated field, ensuring the format is correct.
3. Input the BIN and PCN numbers as specified, ensuring accurate entries to avoid processing delays.
4. Provide the Payer Name and Plan Name/Group Name as required, using 'World Trade Center' for both.
5. Complete the transaction header segment by entering the necessary transaction details including the NCPDP Telecommunication Standard version.
6. Fill out the claim billing segment, providing necessary patient identification details such as name, address, date of birth, and contact information.
7. Enter prescription details in the claim segment, ensuring all fields related to the quantity, product/service ID, and other relevant information are filled out.
8. Review each section for completeness and accuracy, ensuring labels match the required information to facilitate a smooth submission.
9. Finally, save your changes, and you may choose to download, print, or share the completed form as needed.

Complete your documents online to ensure timely submission and processing.