SHIP Claim Form UFTRTC Supplemental Health Insurance Program SHIP Mail to SHIP PO Box 390 Bowling Green Station New York NY 102740390 Please read reverse side for required documents and bene64257t limitation before submitting claim Incomplete claims ID: 7610 Download Pdf
1. 9. Nurses/Home Health Aides2. Ambulance/Ambulette 10. Orthopedic Shoes/Orthotics3. Blood Bank11. DO NOT WRITE IN AREA BELOW (SHIP USE ONLY) Photocopies of this Claim Form are accepted. Yea
Reimbursement Methodology. Go Live 12/31/2016. Jeanne Ciocca 02/16/17. Hospital Preparation Timeline. September 6, 2016. Notification from Maximus to all Acute Care Hospitals, Mass Health . will replace the Payment Amount per Episode (PAPE) with the Adjudicated Payment per Episode (APEC) payment methodology for acute outpatient hospitals on .
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Claim Submission Tips. Provide complete member . . information:. Member ‘s Name. Member’s Date of Birth. Member’s ID Number. Member’s Address. It’s always important to verify that the information provided by the member matches the member’s ID card. Watch for name variations and changes. It is also important to verify eligibility prior to services being rendered, unless an urgent/emergent situation. Problems with member information could cause an unnecessary delay or possible claim denial. .
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SHIP Claim Form UFTRTC Supplemental Health Insurance Program SHIP Mail to SHIP PO Box 390 Bowling Green Station New York NY 102740390 Please read reverse side for required documents and bene64257t limitation before submitting claim Incomplete claims
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