PDF
Word
Form CMS-2384 Third Party Premium Billing Request
What Is Form CMS-2384?
This is a legal form that was released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services on March 1, 2018 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form CMS-2384?
A: Form CMS-2384 is the Third Party Premium Billing Request form.
Q: What is the purpose of Form CMS-2384?
A: The purpose of Form CMS-2384 is to request premium billing for third-party insurance coverage for Medicare beneficiaries.
Q: Who uses Form CMS-2384?
A: Form CMS-2384 is used by health care providers and suppliers who need to bill a third-party insurance company for services provided to Medicare beneficiaries.
Q: What information is required on Form CMS-2384?
A: Form CMS-2384 requires information such as the beneficiary's Medicare information, third-party insurance information, and details of the services provided.
Form Details:
- Released on March 1, 2018;
- The latest available edition released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services;
- Easy to use and ready to print;
- Yours to fill out and keep for your records;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form CMS-2384 by clicking the link below or browse more documents and templates provided by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services.
