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Get Sample Cms 1450 (ub-04) Form: - Kyprolis
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How to fill out the Sample CMS 1450 (UB-04) Form: - Kyprolis online
This guide provides clear and detailed instructions on how to accurately complete the Sample CMS 1450 (UB-04) Form for Kyprolis, ensuring proper billing for outpatient services. Follow the steps below to successfully navigate each section of the form.
Follow the steps to confidently complete your form.
- Use the 'Get Form' button to access the CMS 1450 (UB-04) Form, which will allow you to open and complete the document online.
- In section 1, fill in the patient's information, including their name, birthdate, and sex. Ensure all details are accurate and current.
- Enter the patient address in section 9 to ensure proper identification and correspondence. This address should be where the patient resides.
- In section 13, record the type of bill and the appropriate occurrence codes as specified. Use this section to indicate service-related dates.
- Detail the medication administered in section 18, specifically noting Kyprolis () and any associated revenue code in section 42, referencing the relevant HCPCS code.
- In section 45, indicate the service date and the number of service units in section 46. For Kyprolis, report the units based on the 'per milligram' billing method.
- Complete sections for diagnosis codes, listing relevant ICD-9-CM codes in section 67. This is crucial for proper coding of the condition being treated.
- Finally, review all information for accuracy, then save changes, download the completed form, and print or share it as necessary.
Ensure accurate billing by completing your CMS 1450 (UB-04) Form online today!
To ensure timely and accurate processing of claims, recommends claims be typed, not handwritten. Do not use preprinted or preprogrammed information on the claim form.
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