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Use this form to claim assigned benefits for electronically transmitted claims. Download and complete the Bulk bill voucher - electronically transmitted claims form.
What is a db4 form?
Use this form to claim assigned benefits for electronically transmitted claims. Download and complete the Bulk bill voucher - electronically transmitted claims form. These services can be claimed through HPOS Bulk Bill Webclaim capability.
What does benefit assigned mean?
Assignment of benefits, widely referred to as AOB, is a contractual agreement signed by a policyholder, which enables a third party to file an insurance claim, make repair decisions, and directly bill an insurer on the policyholders behalf.
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This form is required for use by the Public Service Commission of South Carolina for the purpose of docketing and must be filled out completely. DOCKETING
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