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