Get Cms (formerly Hcfa) - Moda Health

Filling out the CMS (formerly HCFA) - Moda Health form can be straightforward if you follow the right steps. This guide offers a clear, step-by-step approach to ensure that all information is accurately provided for processing your healthcare claims.

Follow the steps to successfully complete the CMS form online.

1. Press the ‘Get Form’ button to access the CMS (formerly HCFA) - Moda Health form and open it in your preferred editing tool.
2. Begin by entering the patient’s information in sections 1 through 3. This includes the patient’s name, date of birth, and their address.
3. In section 4, provide the insured’s name, along with their relationship to the patient, which can be self, child, spouse, or another designation.
4. Complete sections 5 and 6 by detailing the patient's status, including whether they are employed or a student, and provide their contact information.
5. Sections 9 through 11 focus on any other insured parties related to the claim and must be filled accordingly if applicable.
6. In sections 12 and 13, the patient and the insured must sign to authorize the release of information and payment of benefits.
7. Fill out the service and charges details in sections 21 through 29, including the diagnosis, dates of service, and applicable charges.
8. Ensure all information is accurate and complete before signing in sections 31 and 32, then finalize any additional necessary details.
9. Finally, save the completed document, then choose to download, print, or share the CMS form as required.

Complete your CMS form online today for efficient claim processing.