Provider Correspondence Fax Cover Sheet For Medical Printable


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Do you need a Medical Provider Correspondence Fax Cover Sheet? Download this professional Provider Correspondence Fax Cover Sheet For Medical Printable template now!


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Do you need a Medical Provider Correspondence Fax Cover Sheet? Download this professional Provider Correspondence Fax Cover Sheet For Medical Printable template now! 

This ready-made and easy-to-customize blank template is well suited for any kind of personalized business matter. Communicating in a professional way will get you and your company respect and will bring you further in life and business. Using our ready to use and easy to modify Provider Correspondence Fax Cover Sheet For Medical Printable brings you an extra motivation and inspiration, and gives you more time to focus on important subjects in your personalized file.

Provider Correspondence Fax Cover Sheet To: TRICARE South Region Claims From: Fax: Fax: Number of pages (including cover sheet): Patient Name: Date(s) of Service: TRICARE Claim Number: Tax Identification Number: (on claim) Reason for Correspondence - Corrected Claim: Corrections to be made: - Referral Information from PCM (claims processed with Point of Service Option) - Duplicate Review – Supporting medical documentation for services denied as a Duplicate - ClaimCheck Review – Supporting medical documentation for services denied per ClaimCheck - Claim Appeal Request - Other: Please use the appropriate secure FAX number from the list below: Routine Correspondence: 803-462-3993 Third Party Liability Forms: 803-462-3987 Other Health Insurance Updates: 803-462-3981 Durable Medical Equipment: 803-462-3982 Authorizations/Referrals: 877-548-1547 Authorization to Disclose Information: 803-462-3984 08/14 Save time as a registered member of myTRICARE.com to manage your TRICARE business online, anytime, day or night You can view claim status, authorization/referral status, PCM name, eligibility, cost-share, copay and deductible information..

We support you by providing this Provider Correspondence Fax Cover Sheet For Medical Printable template, which will save you time, cost and efforts and help you to reach the next level of success in your career and business! 

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