Get Statement Of Services Rendered

Filling out the Statement Of Services Rendered is an essential step in documenting the services provided under the Employee Assistance Program. This guide offers a clear and concise method for completing the form online, ensuring accuracy and compliance with guidelines.

Follow the steps to fill out the Statement Of Services Rendered effectively.

1. Click the ‘Get Form’ button to access the form and open it in your preferred online document editor.
2. Begin by entering the provider's name and obtain the Rendering Provider National Provider Identifier (NPI) for proper identification.
3. Fill in the billing address, ensuring it corresponds to the provider's location for correct invoicing.
4. Indicate the name of the individual or entity to make checks payable to as well as the Tax ID.
5. Provide the Billing Provider National Provider Identifier (NPI) and include a reference number as required.
6. Enter the client's name and the scheduled appointment date, as reported by the client.
7. Input the start date and end date for the services rendered, in line with the client’s treatment timeline.
8. Specify the company and the EAP model utilized during the assistance process.
9. Document the face-to-face session dates in the designated areas to reflect actual sessions conducted.
10. The provider must sign the form to authenticate the completion of services, ensuring all necessary fields are completed.
11. Choose to mail or fax the completed claim; ensure that you have included the accurate addresses and contact numbers.
12. Finally, after reviewing all the entered information, save your changes, and download the form for your records or to print it for submission.

Complete your documentation process online to ensure timely processing and compliance.