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This version of the form is not currently in use and is provided for reference only. Download this version of
Form INS0504
for the current year.
Form INS0504 Third Party Payer - Ohio
What Is Form INS0504?
This is a legal form that was released by the Ohio Department of Insurance - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form INS0504?
A: Form INS0504 is a document specifically for Third Party Payer in Ohio.
Q: What is a Third Party Payer?
A: A Third Party Payer is an entity or person that pays for medical expenses on behalf of the patient.
Q: Who should use Form INS0504?
A: Form INS0504 is intended for use by Third Party Payers in Ohio.
Q: What information is required on Form INS0504?
A: Form INS0504 requires information such as the payer's name, address, contact information, and authorization details.
Form Details:
- Released on January 1, 2019;
- The latest edition provided by the Ohio Department of Insurance;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form INS0504 by clicking the link below or browse more documents and templates provided by the Ohio Department of Insurance.
