20 X Answer

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20 X Answer

20 X Answer

PLEASE PRINT OR TYPE APPROVED OMB 0938 1197 FORM 1500 02 12 S Page 2 Page READ BACK OF FORM BEFORE COMPLETING SIGNING THIS FORM 12 PATIENT S PLEASE PRINT OR TYPE. APPROVED OMB-0938-1197 FORM 1500 (02-12). Page 2. BECAUSE THIS FORM IS USED BY VARIOUS GOVERNMENT AND PRIVATE HEALTH PROGRAMS,SEE ...

CMS 1500

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CMS 1500 Claim Form Carelon Behavioral Health

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