Get Phone Billing Format For Client

Completing the Phone Billing Format For Client is an essential requirement for informing billing processes for each new participant. This guide will walk you through the necessary steps to accurately fill out the form online.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to access the Phone Billing Format For Client and open it in your preferred online editor.
2. In the first section, enter the participant's full name, including their last name, first name, and middle initial.
3. Next, input the participant’s eight-digit medical assistance number, ensuring accuracy in the number sequence.
4. Select the participant's sex by circling either 'M' for male or 'F' for female.
5. Enter the participant’s birthdate in the required format.
6. Provide the name and telephone number of the social worker assigned to the client.
7. Fill in the client diagnosis code using the appropriate number format.
8. Indicate the source of funding by selecting any applicable waiver type and the corresponding county.
9. State the client's budget/program and the number of days attending each week.
10. If applicable, complete the section related to consumer direct options or private pay responsibility.
11. For clients residing in an ICF/MR residence, select the relevant options and provide the residence provider number.
12. Input the host county based on the participant's location in accordance with the guidelines provided.
13. Specify the participant and billing start date to initiate the billing process.
14. Finally, indicate the center that the participant is attending, and ensure to fill your name in the space provided as the form filler.
15. Once all fields are completed, ensure all information is correct, and save your changes. You can then download, print, or share the form as needed.

Complete the Phone Billing Format For Client online today to streamline your billing process.