1500 Claim form

      • 1500 02-12 Fill In The Blank With Calculations(Sign up to download.)
      • 1500 Claim Form Instruction Manual 2012 02-v2(Sign up to download.)

      CPT - Modifiers, Injections, Prolonged Services, Miscellaneous Services

          • CPT Modifiers(Sign up to download.)
          • Preventative Medicine & Obesity Screening And Counseling - Coding And Reimbursement(Sign up to download.)
          • Prolonged Services 99354-99355(Sign up to download.)
          • Relative Value Units CPT (Sign up to download.)
          • Review Of Records 99358-99359(Sign up to download.)
          • Telephone Calls And On-line Evaluation (Sign up to download.)

          Correspondence & Fight Back Letters

              Denial of E&M with Acupuncture

            • Denial Of E&M Code Billed With Acupuncture PDF(Sign up to download.)
            • Insurance Disputing Fees

            • Usual Customary And Reasonable Fee Reduction (editable)(Sign up to download.)
            • Usual Customary And Reasonable Fee Reduction PDF(Sign up to download.)
            • Insurance requesting a refund

            • Insurance Requesting A Refund (editable)(Sign up to download.)
            • Insurance Requesting A Refund PDF(Sign up to download.)
            • Insurance Requesting A Refund, Extended Response PDF(Sign up to download.)
            • Maintenance and Medical Necessity Denials

            • Acupuncture Medical Necessity Denial PDF(Sign up to download.)
            • Maintenance Care Denial (editable)(Sign up to download.)
            • Maintenance Care Denial PDF(Sign up to download.)
            • Patient Collection

            • Patient Late Pay When They Receive The Check (PDF)(Sign up to download.)
            • Patient Late Pay When They Receive The Check (editable)(Sign up to download.)
            • Patient Late Pay When They Receive The Check(Sign up to download.)
            • Patient Late Pay (PDF)(Sign up to download.)
            • Patient Late Pay (editable)(Sign up to download.)
            • Personal Injury

            • Attorney Holding Med Pay(Sign up to download.)
            • Attorney Holding Med Pay(Sign up to download.)
            • Attorney Late Payment With Signed Lien(Sign up to download.)
            • Attorney Late Payment With Signed Lien(Sign up to download.)
            • Attorney Status Of Claim(Sign up to download.)
            • Attorney Status Of Claim(Sign up to download.)
            • Attorney Cover Letter With Lien(Sign up to download.)
            • Attorney Cover Letter With Lien(Sign up to download.)
            • Attorney Negotation To Reduce Settlement Rejection(Sign up to download.)
            • Attorney Negotation To Reduce Settlement Rejection(Sign up to download.)
            • Attorney Not Paying Settled Claim(Sign up to download.)
            • Attorney Not Paying Settled Claim(Sign up to download.)
            • Attorney Paying Reduced Amount Rejection(Sign up to download.)
            • Attorney Paying Reduced Amount Rejection(Sign up to download.)
            • Deposition Expert Witness Fees(Sign up to download.)
            • Deposition Expert Witness Fees(Sign up to download.)
            • Excess Med Pay HMO Primary(Sign up to download.)
            • Excess Med Pay HMO Primary(Sign up to download.)
            • Excess Med Pay No Primary Health Insurance(Sign up to download.)
            • Excess Med Pay No Primary Health Insurance(Sign up to download.)
            • Patient Late Payment Of Settled Claim 2(Sign up to download.)
            • Patient Late Payment Of Settled Claim 2(Sign up to download.)
            • Patient Late Payment Of Settled Claim(Sign up to download.)
            • Patient Late Payment Of Settled Claim(Sign up to download.)
            • Termination of PPO Contract

            • Termination Of PPO Contract (PDF)(Sign up to download.)
            • Termination Of PPO Contract (editable)(Sign up to download.)
            • Timely Filing Dispute

            • Timely Filing Dispute (PDF)(Sign up to download.)
            • Timely Filing Dispute (editable)(Sign up to download.)
            • Withdrawal from care

            • Withdrawal From Care (PDF)(Sign up to download.)
            • Withdrawal From Care (editable)(Sign up to download.)
            • Documentation

                  • Documentation Of Acupuncture(Sign up to download.)

                  External Causes of Injury ICD9 & ICD10 Codes

                      • E Codes ICD9 External Causes Of Injury(Sign up to download.)
                      • V Codes ICD10 Auto Accidents(Sign up to download.)
                      • V, W, X, Y, & Z Codes ICD 10 Morbidity & Health Status Codes(Sign up to download.)

                      Financial Agreements

                          Cash and-or Insurance

                        • Financial Policy & Agreement (PDF)(Sign up to download.)
                        • Financial Policy & Agreement (editable)(Sign up to download.)
                        • Credit Card Authorization

                        • Credit Card Authorization For Past Due Payments(Sign up to download.)
                        • Financial Hardship

                        • Financial Hardship Agreement (PDF)(Sign up to download.)
                        • Financial Hardship Agreement (editable)(Sign up to download.)
                        • Insurance

                        • Health Insurance Acupuncture (PDF)(Sign up to download.)
                        • Health Insurance Acupuncture (editable)(Sign up to download.)
                        • Personal Injury (auto accidents)

                        • Personal Injury Financial Agreement (PDF)(Sign up to download.)
                        • Personal Injury Financial Agreement (editable)(Sign up to download.)
                        • Forms (History, exam, consultation, lien, assignment of benefits)

                              Assignment of Benefits

                            • Assignment Of Benefits(Sign up to download.)
                            • Examination

                            • Examination Report (single Page)(Sign up to download.)
                            • Review Of Systems(Sign up to download.)
                            • History, Consultation & Examination

                            • Case History Including Accident Information (2 Pages)(Sign up to download.)
                            • History, Consultation & Examination (4 Pages)(Sign up to download.)
                            • History, Examination Detailed (8 Pages) PDF Acupuncture 2016 Update(Sign up to download.)
                            • History, Examination Detailed (8 Pages) Editable Acupuncture 2016 Update(Sign up to download.)
                            • Patient History Update(Sign up to download.)
                            • Personal Injury Questionnaire(Sign up to download.)
                            • Personal Injury Lien

                            • Notice Of Doctors Lien(Sign up to download.)
                            • SOAP & Daily Notes

                            • Treatment Notes, Single Page(Sign up to download.)
                            • HCPCS Orthotics and DME Common Codes

                                  • HCPCS Common Codes(Sign up to download.)

                                  HIPAA Privacy Notices

                                      • Business Associate Agreement Acupuncture (editable)(Sign up to download.)
                                      • Business Associate Agreement Acupuncture PDF(Sign up to download.)
                                      • HIPAA Privacy Notice (editable)(Sign up to download.)
                                      • HIPAA Privacy Notice PDF(Sign up to download.)
                                      • Request For Records(Sign up to download.)

                                      Informed Consent

                                          • Acupuncture Arbitration Agreement And Informed Consent - FED(Sign up to download.)
                                          • Informed Consent Acupuncture - California(Sign up to download.)
                                          • Informed Consent Acupuncture- Federal(Sign up to download.)

                                          Insurance Acupuncture Coverage Policies

                                              Aetna

                                            • Acupuncture Clinical Policy Bulletin 0135 Updated 2018 (Sign up to download.)
                                            • Blue Cross and Blue Shield

                                            • Anthem Acupuncture Clincal Guideline CG-ANC-03(Sign up to download.)
                                            • Excellus Blue Cross Blue Shield Acupuncture Policy(Sign up to download.)
                                            • Regence Blue Cross Blue Shield Acupuncture Coverage(Sign up to download.)
                                            • Cigna

                                            • Cigna Medical Coverage Policy Acupuncture 2018 Update(Sign up to download.)
                                            • Evicore - Anthem Blue

                                            • Evicore Acupuncture Guidelines 2019(Sign up to download.)
                                            • Health Net

                                            • Health Net Acupuncture(Sign up to download.)
                                            • HealthPartners

                                            • Health Partners Acupuncture Coverage 2018(Sign up to download.)
                                            • United Health Care

                                            • United Health Care Acupuncture Policy(Sign up to download.)
                                            • Insurance Billing Protocol and Sample Bills

                                                  • Acupuncture Insurance Billing Protocol Step-by-Step(Sign up to download.)
                                                  • Group Practice Or Corporation Acupuncture Billing(Sign up to download.)
                                                  • Initial Acupuncture Visit - E&M With Acupuncture(Sign up to download.)
                                                  • Subsequent Acupuncture Visit With Multiple Units Of Acupuncture(Sign up to download.)
                                                  • Subsequent Acupuncture Visit With Therapy(Sign up to download.)
                                                  • Subsequent Acupuncture Visit(Sign up to download.)

                                                  Insurance Verification Form

                                                      • Insurance Verification Acupuncture(Sign up to download.)

                                                      Outcome Assessments & Disability Indexes

                                                          Balance

                                                        • Balance Test - Tinetti(Sign up to download.)
                                                        • Berg Balance Scale(Sign up to download.)
                                                        • Concussion

                                                        • Acute Concussion Evaluation(Sign up to download.)
                                                        • Depression

                                                        • Depression Assessment(Sign up to download.)
                                                        • Extremities

                                                        • Disabilities Of The Shoulder And Hand(Sign up to download.)
                                                        • Lower Extremity Functional Scale(Sign up to download.)
                                                        • Gait

                                                        • Gait Assessment - Tinetti(Sign up to download.)
                                                        • Headache

                                                        • Headache Disability Index(Sign up to download.)
                                                        • Pain & Health Survey

                                                        • Fear Avoidance Behavior Questionnaire(Sign up to download.)
                                                        • Fear Avoidance Beliefs Questionnaire(Sign up to download.)
                                                        • General Pain Index(Sign up to download.)
                                                        • McGill Pain Questionnaire(Sign up to download.)
                                                        • McGill Short Form(Sign up to download.)
                                                        • Pain Scale With General Pain Index(Sign up to download.)
                                                        • Patient-specific-functional-scale(Sign up to download.)
                                                        • Picture Pain Disability(Sign up to download.)
                                                        • SF36 General Health Survey(Sign up to download.)
                                                        • SF36 Scoring(Sign up to download.)
                                                        • Pain and Function Scale Veterans

                                                        • VA Pain Rating Scale(Sign up to download.)
                                                        • VA Pain Supplemental Questions(Sign up to download.)
                                                        • Sleepiness Scale

                                                        • Epworth Sleepiness Scale(Sign up to download.)
                                                        • Spine

                                                        • Copenhagen Neck Disability(Sign up to download.)
                                                        • Neck Disability Index(Sign up to download.)
                                                        • Neck Disability Scoring Method(Sign up to download.)
                                                        • Oswestry Low Back Disability Index(Sign up to download.)
                                                        • Oswestry Scoring Method(Sign up to download.)
                                                        • Roland Morris (Low Back)(Sign up to download.)
                                                        • TMJ

                                                        • TMJ Questionnaire(Sign up to download.)
                                                        • Superbill

                                                              • Acupuncture Superbill (editable With MS Excel)(Sign up to download.)
                                                              • Acupuncture Superbill ICD10 Update 2019(Sign up to download.)

                                                              Treatment Guidelines

                                                                  ACOEM

                                                                • Ankle-and-Foot-Disorders-Guideline-1(Sign up to download.)
                                                                • Cervical-and-Thoracic-Spine-Disorders-Guideline-1(Sign up to download.)
                                                                • Elbow-Disorders-Guideline-1(Sign up to download.)
                                                                • Hand-Wrist-and-Forearm-Disorders-Guideline(Sign up to download.)
                                                                • Hip-and-Groin-Disorders-Guideline-1(Sign up to download.)
                                                                • Initial-Approaches-to-Treatment-Guideline(Sign up to download.)
                                                                • Low-Back-Disorders-Guideline-1(Sign up to download.)
                                                                • Opioids-Guideline-1(Sign up to download.)
                                                                • Opioids-Guideline(Sign up to download.)
                                                                • Shoulder-Disorders-Guideline(Sign up to download.)
                                                                • Acupuncture General Guidelines

                                                                • Acupuncture Evidence Based Treatment Guidelines(Sign up to download.)
                                                                • Acupuncture And Electroacupuncture TreatmentGuidelines(Sign up to download.)
                                                                • Chronic Pain Disorder

                                                                • Chronic Pain Disorder (searchable For Acupuncture)(Sign up to download.)
                                                                • Non-Acute Pain Medical Treatment Guideline (searchable For Acupuncture)(Sign up to download.)
                                                                • Complex Regional Pain Syndrome

                                                                  Cumualtive Trauma

                                                                • Cumulative Trauma Conditions (searchable For Acupuncture)(Sign up to download.)
                                                                • Extremities

                                                                • Carpal Tunnel Medical Treatment Guideline (searchable For Acupuncture)(Sign up to download.)
                                                                • Knee Injury Medical Treatment Guideline (searchable For Acupuncture)(Sign up to download.)
                                                                • Lower Extremity Injury (searchable For Acupuncture)(Sign up to download.)
                                                                • Shoulder Injury (searchable For Acupuncture)(Sign up to download.)
                                                                • Shoulder Injury Medical Treatment Guideline (searchable For Acupuncture)(Sign up to download.)
                                                                • Spine

                                                                • Cervical Spine Injury (searchable For Acupuncture)(Sign up to download.)
                                                                • Low Back Pain (searchable For Acupuncture)(Sign up to download.)
                                                                • Mid And Low Back Injury Medical Treatment Guideline (searchable For Acupuncture)(Sign up to download.)
                                                                • Neck Injury Medical Treatment Guideline (searchable For Acupuncture)(Sign up to download.)
                                                                • Thoracic Outlet Syndrome (searchable For Acupuncture)(Sign up to download.)