Client agrees to fax on a daily or weekly basis, so that all claims will be submitted on a timely basis and shall include the following information:

  1. Complete primary and secondary insurance information;
  2. Complete legible demographics on patient, including, but not limited to, name, address, phone number, member identification, date of birth; (hospital face sheet)
  3. Physician information, including full name and address; contact information
  4. Facility name and address where procedure was performed;
  5. Complete list of procedures (CPT) and (DX) for each surgery;
  6. Date of surgery.