EssayWr

View attached explanation and answer. Let me know if you have any questions.CARRIERMDWizards.comHEALTH INSURANCE CLAIM FORMAPPROVED BY NATIONAL UNIFORM CLAIM COMMITTEE (NUCC) 02/12PICA(Medicare #)MEDICAIDTRICARECHAMPVA(Medicaid #)(ID#/DoD#)(Member ID#)GROUPHEALTH PLAN(ID#)3. PATIENT’S BIRTH DATEMMDDYY2. PATIENT’S NAME (Last Name, First Name, Middle Initial)Jennifer Peter M.035. PATIENT’S ADDRESS (No., Street)10OTHERFECABLK LUNG(ID#)(ID#)F6. PATIENT RELATIONSHIP TO INSUREDCA 90008-3014SelfCITYSTATELOS ANGELESCAZIP CODETELEPHONE (Include Area Code)90008( … Read more