CMS L564. Request for employment information
Form CMS L564/R297, approved by the Centers for Medicare & Medicaid Services (CMS), is an official Request for Employment Information. This form is primarily used to verify group health plan coverage when applying for Medicare during a Special Enrollment Period (SEP).
Consent to Treat Minor Children Form
A consent to treat minor children form is a document used to authorize medical treatment for a minor child in the absence of the child's legal guardian. The main purpose of the form is to allow a responsible adult to make medical decisions on behalf of a minor child.
CMS 1763. Request for Termination of Premium Hospital Insurance of Supplementary Medical Insurance
CMS 1763 is a form used to request the termination of premium hospital insurance or supplementary medical insurance. The main purpose of the form is to allow individuals to cancel their Medicare Part A or Part B coverage.
SF 428B. Tangible Personal Property Report - Final Report
Form SF 428B Tangible Personal Property Report - Final Report is a document used by federal government agencies to provide a final inventory of tangible personal property that is no longer in the agency's possession.
Prior Authorization Form
A Prior Authorization form is a document that healthcare providers use to request approval from an insurance company or other payer to cover a specific medical treatment or service.
HIPAA Authorization Form
The HIPAA Authorization Form is a document that enables individuals to authorize the release of their protected health information (PHI) to third-party entities.
SF 428. Tangible Personal Property Report
Form SF 428 Tangible Personal Property Report is a document used by federal government agencies to report and track tangible personal property in their possession.
HIPAA release form
A Release of Information Form HIPAA is a legal document used in the United States to obtain a patient's authorization to disclose their protected health information (PHI) to third parties. The main purpose of the form is to ensure HIPAA compliance and protect the privacy of patients.
Form CMS-R-131. FFS ABN
Form CMS-R-131, also known as the Advance Beneficiary Notice of Noncoverage (ABN), is a notice that healthcare providers give to Medicare beneficiaries to inform them that Medicare may not pay for a particular service or item they are receiving, and that the beneficiary may be responsible for pay
CMS 10123. FFS & MA NOMNC/DENC
The FFS & MA NOMNC/DENC form is used to notify Medicare beneficiaries of their right to appeal a decision regarding their Medicare coverage.