UB04 Billing Instructions Guide - Maine

Feb 25, 2021 · Enter the member’s name in this order: last name, first name, and middle initial. The name must be exactly the same as the name printed on the member’s MaineCare ID card. FL 9 a — e: PATIENT ADDRESS. a through d are required; e is not required. Figure 3 8: FL9a-e Patient Address. FL 9a: Enter the member’s street address or P.O. Box. FL ... ................
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