Get Modifier 22 Documentation Form - Wps

Filling out the Modifier 22 Documentation Form - WPS is an essential process for documenting services that go beyond typical complexities. This guide will provide you with clear, step-by-step instructions to assist you in completing the form accurately and efficiently online.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to access the Modifier 22 Documentation Form and open it in your document editor.
2. Begin by entering your provider information. Fill in your name, PTAN, and NPI accurately in the designated fields. Ensure that this information is current and matches your records.
3. Next, complete the claim information section. This includes the date of service (DOS) and a clear statement describing the unusual circumstances of the service, justifying the use of the Modifier 22. Avoid vague phrases and provide specific details that set your case apart.
4. Proceed to the patient information section. Enter the patient's name, Health Insurance Claim Number (HICN), date of birth (DOB), and the date of completing the form.
5. In the signature section, the responsible party must sign and indicate their title. This verifies the accuracy of the details provided.
6. Finally, review all sections for completeness and accuracy. Once satisfied with your entries, you may save your changes, download a copy for your records, print the form, or share it as needed.

Take action now and complete your documents online to ensure accurate processing.