ANSWERS
Section 1 - ANSWER Health Care Coverage Being Billed
Section 2 - ANSWER Patient's Name
Section 4 - ANSWER Insured Name
Section 10A - ANSWER Patient Condition is result of employment
Section 11 - ANSWER Insured Policy Group or FECA number
Section 11D - ANSWER Another Health Plan
Section 17 - ANSWER Name of referred provider
Section 21 - ANSWER Diagnosis Code
Section 24D - ANSWER Procedure Code
Section 25 - ANSWER Federal tax ID number