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  • Signature Must Be Complete And Legible. This Form...

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Submit to: AmeriHealth Administrators Administrative Appeals P.O. Box 21974 Eagan, MN 55121 FAX to: (215) 761-0956 YOU MUST COMPLETE A SEPARATE APPLICATION FOR EACH CLAIM APPEALED. A. Provider Information.

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No, stamped signatures are not acceptable. Medicare requires services provided/ordered/certified be authenticated by the persons responsible for the care of the beneficiary. Only handwritten or electronic signatures are acceptable.

In order to be considered valid for Medicare medical review purposes, an attestation statement must be signed and dated by the author of the medical record entry and must contain sufficient information to identify the beneficiary.

Signature Logs Type or print the provider's credential. The physician (provider) should sign his/her legal signature (full name, including credential). Under Actual Chart Signature, the provider should indicate all possible ways that he/she would sign the medical record (initials, first initial/last name, etc.).

What is the Centers of Medicare and Medicaid Services (CMS) definition of legible documentation? That the data must be easily recognizable by someone outside of the medical practice who is unfamiliar with the handwritting.

Acceptable electronic signature methods include: A typed name typed on a signature block. A scanned or digitized image of a handwritten signature that's attached to an electronic record. A handwritten signature input onto an electronic signature pad.

The signature for each entry must be legible and should include the practitioner's first and last name.

The document must state the capacity of the person signing; his or her address, phone number, and e-mail address; and the date of signature.

Acceptable electronic signature methods include: A typed name typed on a signature block. A scanned or digitized image of a handwritten signature that's attached to an electronic record. A handwritten signature input onto an electronic signature pad.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232