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Get General Claim Submission Form - Providerconnect
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How to fill out the GENERAL CLAIM SUBMISSION FORM - ProviderConnect online
Filing a claim can seem daunting, but with clear steps, you can efficiently complete the GENERAL CLAIM SUBMISSION FORM on ProviderConnect. This guide offers a comprehensive overview of each section of the form, helping you navigate the submission process with confidence.
Follow the steps to complete your claim submission form
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Section 1 requires you to enter plan member information. Fill in the Green Shield Canada ID number, email address, surname, first name, phone number, address, company name, city, province, and postal code. Ensure all information is accurate and current.
- In Section 2, answer the mandatory declaration questions. Indicate whether you have other group insurance coverage and provide details if applicable. Additionally, specify if you wish to coordinate this claim with any other coverage or if treatment is related to a motor vehicle accident or work-related injury.
- Section 3 focuses on claim details. Enter the patient's name, date of birth, professional/supplier’s name (if available), date of claim, type of expense, total amount charged per visit/item, and total claimed. Include any specific details required for prescription drug claims, ensuring you comply with the receipt specifications.
- Section 4 requires the signature of the plan member and the date. This signature confirms the accuracy of the information provided and authorizes Green Shield Canada to use the information for claims processing.
- Refer to Section 5 for mailing instructions. Ensure that you enclose all original documentation and understand that claims must be submitted within 12 months of the date of service. Choose the appropriate mailing address based on your type of claim.
- After completing all sections, you can save your changes, download a copy of the form, print it for your records, or share it as needed.
Complete your claims submission online today to ensure timely processing!
Completing an insurance claim form requires providing specific details about the incident and the coverage involved. Ensure that you reference the relevant policy numbers and include any documentation needed to support your claim. Using the GENERAL CLAIM SUBMISSION FORM - ProviderConnect can streamline the submission process and help you avoid common pitfalls.
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