FINAL

Created by Bridgett39 

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UB

UNIVERSAL FORM

UB04

INPATIENT FORM (CLAIM) FORM HOSPITAL

MEDICARE

65YRS AND END STAGE RENAL DISEASE (ESRD)

MEDICAID

LOW INCOME, UNDER 18, PREGNANT, TEMP DIDABILITY

BWC

ASSIST PEOPLE INJURED AT WORK FOR MEDICAL & MISSED WAGES

TRICARE

80/20 & DEDUCTIBLE ACTIVITY RETIRED & FAMILIES

HMO

NEED REFFERALS, PRIOR AUTHORIZATION, STAY IN NETWORK

PPO

HIGHER PREMIUM, CAN GO OUT OF NETWORK

1500 CLAIM

ALL OUT PATIENT SERVICES

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