Get Simplified Billing Doctor Claim Form - Latrobe Health Services

This guide provides clear instructions for users on how to complete the Simplified Billing Doctor Claim Form for Latrobe Health Services online. By following these steps, you can ensure that your form is filled out correctly and submitted efficiently.

Follow the steps to fill out the form accurately

1. Press the ‘Get Form’ button to download the form and open it in your preferred editor.
2. In Section 1, enter the practice and patient details. Fill in the practice name, practitioner name, provider number, address, postcode, and phone number. Then, input the patient's name, Medicare number, card reference number, date of birth, and membership number.
3. Review the declaration statement in the same section. Ensure you understand and agree to the terms regarding the services rendered and billing.
4. In Section 2, complete the account details if you have not submitted an account with the claim form. Enter the relevant MBS/MBAC item number, description of the service, number of patients seen, date of service, provider number, and full charge including any patient out-of-pocket expenses.
5. In Section 3, outline the referral details. Circle the appropriate period, and provide the referral date, referring provider's name, provider number, address, and postcode.
6. In Section 4, answer the questions regarding applicable service conditions by marking 'Yes' or 'No' for each item.
7. Once all sections are complete, review the entire form for accuracy. You can then save changes, download, print, or share the form as needed.

Complete your Simplified Billing Doctor Claim Form online today and ensure timely processing of your claim.