BILLING FORM. The PHP shall use the Centers for Medicare and Medicaid Services (CMS) 1450 UB-04 billing form and the CMS 1500 Claim Form for outpatient services (or subsequent editions). PHPs shall identify PHP care on the billing form in the remarks block by stating “PHP care”.
Appears in 16 contracts
Samples: Participation Agreement for Freestanding Psychiatric and Substance Use Disorder (Sud) Partial Hospitalization Program (Php) Services, Participation Agreement, Participation Agreement for Freestanding Psychiatric and Substance Use Disorder (Sud) Partial Hospitalization Program (Php) Services
BILLING FORM. The PHP shall use the Centers for Medicare and Medicaid Services (CMS) 1450 UB-04 billing form and the CMS 1500 Claim Form for outpatient services (or subsequent editions). PHPs shall identify PHP care on the billing form in the remarks block by stating “PHP care”.
Appears in 6 contracts
Samples: Participation Agreement, Participation Agreement for Freestanding Psychiatric Partial Hospitalization Program (Php) Services, Participation Agreement
BILLING FORM. The PHP shall use the Centers for Medicare and Medicaid Services (CMS) 1450 UB-04 billing form and the CMS 1500 Claim Form for outpatient services (or most current subsequent editions). PHPs shall identify PHP care on the billing form in the remarks block by stating “PHP care”.
Appears in 2 contracts
Samples: Participation Agreement for Hospital Based Psychiatric Partial Hospitalization Program (Php) Services, Participation Agreement
