This is a 65-year-old lady with complaints of low-back pain

Week 3 Project Use the blank PDF CMS-1500 Form for this assignment: Blank CMS 1500 claim form.pdf Blank CMS 1500 claim form.pdf – Alternative Formats Download a copy of the blank CMS-1500 pdf claim form and save it to your desktop. Using the information from Chapter 11, complete the claim using the Gladys Phish case study below. Save your entries and upload your claim using the “Week 3 Project” link. (See the Mary Hightower example.) (If you have technical issues saving the edited form, be sure you download the latest Adobe Acrobat Reader.) Image transcription text HEALTH INSURANCE CLAIM FORM | CARRIER – APPROVED BY NATIONAL UNIFORM CLAIM COMMITTEE (NUCC) 02/12 PICA PICA ME… Show more 2. GladysPhish.pdf GladysPhish.pdf – Alternative Formats (case study). Use the information in the case study to complete your blank 1500 claim form. Image transcription text Case Study 1-7 Gladys Phish ANGELA DILALIO MD 99 PROVIDER DRIVE INJURY NY 12347 101 2014321 Patient Number: 1-7 EIN: 111982342 NPI: 456789012… Show more

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