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Form HFS1443 Provider Invoice Example Only (Ocr) - Illinois
What Is Form HFS1443?
This is a legal form that was released by the Illinois Department of Healthcare and Family Services - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is HFS1443 Provider Invoice?A: HFS1443 Provider Invoice is a form used for submitting invoices to the Illinois Department of Healthcare and Family Services (HFS) for reimbursement.
Q: Who can use the HFS1443 Provider Invoice?A: Healthcare providers in Illinois who are enrolled in the HFS Medical Assistance Program can use the HFS1443 Provider Invoice.
Q: What information is required on the HFS1443 Provider Invoice?A: The HFS1443 Provider Invoice requires information such as the provider's name, address, National Provider Identifier (NPI), service dates, procedure codes, billed amounts, and more.
Q: Is the HFS1443 Provider Invoice specific to Illinois?A: Yes, the HFS1443 Provider Invoice is specific to healthcare providers in Illinois who participate in the HFS Medical Assistance Program.
Form Details:
- Released on July 1, 2005;
- The latest edition provided by the Illinois Department of Healthcare and Family Services;
- 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 printable version of Form HFS1443 by clicking the link below or browse more documents and templates provided by the Illinois Department of Healthcare and Family Services.
Download Form HFS1443 Provider Invoice Example Only (Ocr) - Illinois
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