Obtenga un formulario o publicación: Billing Instructions
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| Título | Tipo | Número |
|---|---|---|
General Provider Billing Manual General billing information for those providers that bill the department. |
Manual | F248-100-000 |
| Statement for Compound Prescription
Bill form for use by pharmacies and home infusion companies to submit compound drug charges. This form is for drug charges only, and is filled out by the pharmacist. See the Pharmacy Billing Instructions (F248-021-000) for information on completing this form. |
Form | F245-010-000 |
| Statement for Retraining and Job Modification Services
Bill form for providers that bill the department for claim-related retraining and job modification services. See the Retraining and Job Modification Billing Instructions (F248-015-000) for information on completing this form. |
Form | F245-030-000 |
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