Get Wi Cologuard Form Frm-3004-05-c 2019-2025
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How to fill out the WI Cologuard Form FRM-3004-05-c online
This guide provides a comprehensive overview of how to accurately complete the WI Cologuard Form FRM-3004-05-c online. Our aim is to support users in effectively navigating each section of the form with clarity and confidence.
Follow the steps to fill out the form correctly.
- Click the ‘Get Form’ button to obtain the form and open it in an online editor.
- Begin with the provider & order information section. Fill in the healthcare organization name and provider name. Ensure that all information is typed clearly for readability.
- Next, locate the ICD-10 code section. Input the appropriate diagnosis code that describes the reason for the test, ensuring accuracy.
- Provide the NPI number of the provider and the location address, including city, state, and zip code, as well as a phone number and secure fax number to receive results.
- In the patient demographics section, enter the patient's ID or medical record number, first name, last name, and date of birth in the specified format (mm/dd/yyyy).
- Indicate the patient's sex by selecting the appropriate option between male and female.
- Fill out the shipping address and contact phone number for the patient. Ensure to select a preferred phone type (home, mobile, work).
- Complete the optional patient ethnicity and race section if applicable. Specify if the patient is of Hispanic or Latino origin and indicate race categories as needed.
- For patient insurance/billing information, decide whether Exact Sciences should bill their insurance. Complete the necessary fields for policyholder name, policyholder date of birth, and relationship to the patient if yes is selected.
- Enter primary insurance carrier details including type and claims submission address. Input subscriber ID, group number, and prior-authorization code if available.
- Lastly, ensure the patient authorizes the billing and assigns benefits. The patient must sign and date the authorization section.
- After filling out the form, review all entries for accuracy. Save your changes, and then download, print, or share the completed form as needed.
Complete your documents online to ensure accuracy and efficiency.
The coverage for Cologuard often depends on your insurance provider and your specific health plan. Generally, many insurance plans will cover the costs associated with the WI Cologuard Form FRM-3004-05-c, particularly for individuals who meet certain risk criteria. It is advisable to contact your insurance company directly to confirm your coverage and any potential out-of-pocket expenses. For additional assistance, uslegalforms can help you navigate these options and provide necessary forms.
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