GUIDELINES
Guidelines.12021v Effective 10/1/2021 Important notice: Those who call the CHM office detailing their circumstances and asking if medical bills qualify will be given an opinion, not a decision. Bills cannot be authorized for CHM sharing over the phone.
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2018 Form 8965 - chministries.org
www.chministries.org8965 t the Treasury Internal Revenue return Health Coverage Exemptions Attach to Form 1040. GO to www.irs.goWForm8965 for instructions and the latest information.
Acciden Veri˜ca Form - chministries.org
www.chministries.orgMOTOR VEHICLE ACCIDENT (AUTO, MOTORCYCLE, BOAT, ETC) Was the patient the: square Driversquare Passenger square Pedestrian List if the injury/accident occurred on private or public property: Name and address of the liable party: Insurance company: Claim/policy #: Address: Phone #: Adjuster’s name: Phone #:
Sharing Request Form
www.chministries.orgPatient Name: Date of birth: Member#: Instructions: Complete each column to reflect the dollar amounts associated with each itemized bill’s initial charges, reductions, and other payment details. Is this worksheet an add-on (a bill, form or letter related to an incident already been submitted) to a previous incident?
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