Driscoll Health Plan
Provider Collaboration Portal
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Certification: I certify that the information supplied in this document constitutes true, accurate, and complete information and is supported in the medical record of the patient. I understand that falsifying entries, concealment of a material fact, or pertinent omissions may constitute fraud, waste or abuse and result in denial of payment.
Copyright © 2011 Trinity Computer Services Inc. DBA: TCS Healthcare Technologies. All Rights Reserved.
CPT® copyright 2010 American Medical Association. All rights reserved.
Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
CPT is a registered trademark of the American Medical Association. This product also contains AMA's version of ICD-9-CM and HCPCS.
Applicable FARS/DFARS Restrictions Apply to Government Use
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