Get Au 4703 2013

The AU 4703 form is essential for health professionals wishing to acknowledge overpayments received under the Medicare program due to incorrect claims. This guide offers step-by-step instructions to assist you in completing the form accurately and efficiently.

Follow the steps to complete the AU 4703 form online.

1. Click ‘Get Form’ button to access the AU 4703 document and open it in your editor.
2. Fill in your details in the ‘Your details’ section, including your title, family name, and other given names, provider number, and contact information. Ensure all information is entered in block letters using a black or blue pen.
3. Provide the date of service and any relevant details of services associated with your voluntary acknowledgement. Include patient first name, patient surname, patient date of birth or Medicare card number, item number, and claiming issue description.
4. If applicable, provide the audit reference number and the date that any Section 129AAD notice was issued.
5. Carefully review your completed form to ensure all questions are answered, and your declaration section is signed and dated, confirming that your information is complete and correct.
6. Once you have completed the form, you can save your changes, download a copy, print it for your records, or share it as needed.

Complete your voluntary acknowledgement of incorrect payments by filing the AU 4703 form online today.