Get Reference List For Gsk Vaccines Coding - Gsk Source

This guide provides clear and comprehensive instructions for users on how to fill out the Reference List For GSK Vaccines Coding - GSK Source online. The following steps will help you navigate each section and field with ease.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the Reference List For GSK Vaccines Coding - GSK Source. This will open the form for you to begin filling it out.
2. In the Product Information section, enter the vaccine name, the National Drug Code (NDC) if applicable, the Current Procedural Terminology (CPT) code, and the International Classification of Diseases (ICD-10) code if available.
3. Proceed to the Physician Information section. Enter the physician's name, practice name, street address, city, phone number, email, fax number, National Provider Identifier (NPI), state, ZIP code, office contact name, Provider Transaction Access Number (PTAN) if applicable, and tax ID.
4. Next, fill out the Patient Information section. Input the patient's first and last name, phone number, date of birth, street address, city, state, and ZIP code. Indicate the patient's gender by selecting either male or female.
5. In the Insurance Information section, include the primary medical insurance name or Medicare Part D plan name, the insurance company’s phone number, subscriber name, relationship to the patient, subscriber ID number, and group ID number. Remember to attach copies of the front and back of the patient insurance cards.
6. Review the Application Checklist to ensure you have completed the Enrollment form. Either the patient or the healthcare provider's representative must sign the completed form in Section 1 or Section 2. Make sure to check that the appropriate section has been signed.
7. Once you have filled out all sections and signed the form, fax both pages to the GSK Vaccines Reimbursement Support Center at 877-683-1329. If you have any questions, you can reach out to them at 855-636-8291.

Complete your form online now to ensure timely processing.