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Form MHA095 Insurance / Medicare Payment Notification Form - Contra Costa County, California
What Is Form MHA095?
This is a legal form that was released by the Health Services Department - Contra Costa County, California - a government authority operating within California. The form may be used strictly within Contra Costa County. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is form MHA095?A: Form MHA095 is the Insurance/Medicare Payment Notification Form.
Q: What is the purpose of form MHA095?A: The purpose of form MHA095 is to notify Contra Costa County of insurance or Medicare payments.
Q: Who needs to fill out form MHA095?A: Form MHA095 needs to be filled out by individuals who have received insurance or Medicare payments.
Q: Is form MHA095 specific to a particular insurance provider?A: No, form MHA095 is not specific to a particular insurance provider. It is used to report any insurance or Medicare payments received.
Form Details:
- Released on June 1, 2018;
- The latest edition provided by the Health Services Department - Contra Costa County, California;
- 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 MHA095 by clicking the link below or browse more documents and templates provided by the Health Services Department - Contra Costa County, California.
