Direct Submission to Secondary Insurance for Medicare Non-Covered Services Form for Chiropractic

Sample form for Direct Submission for Medicare Non-Covered Services for Chiropractic.

Direct Submission could be an effective way to avoid payment delays for Medicare Secondary payers. Some services are often the primary responsibility of what is commonly known as the Medicare Secondary Payers. This letter is for direct submission to these payers via paper claims.

This letter assumes the patient has paid for their services. If it has not been paid, replace the second paragraph with “This claim has not been paid by the patient.”

Download Forms:

• Direct Submission to Secondary Insurance for Medicare Non-Covered Services Form for Chiropractic