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GENERAL CLAIM SUBMISSION FORM SECTION 1 PLAN MEMBER INFORMATION GREEN SHIELD CANADA ID NUMBER EMAIL ADDRESS SURNAME FIRST NAME PHONE NUMBER ADDRESS COMPANY NAME CITY PROVINCE POSTAL CODE SECTION 2.

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The Administrative Simplification Compliance Act (ASCA) requires that Medicare claims be sent electronically unless certain exceptions are met. Providers meeting an ASCA exception may send their claims to Medicare on a paper claim form.

A claim form is the document that must be completed by a claimant when they commence civil proceedings in the County Court or High Court.

The CMS-1500 form, popularly known as the Professional Paper Claim Form, is a medical claim form that can be used by non-institutional providers and suppliers to bill claims.

In order to be considered, claims must be received by GreenShield within 12 months of the date of service (unless otherwise stated in your benefit plan documentation).

Complete all fields and fax to 877- 439-5479 or mail the form to the applicable address/number provided at the bottom of the page. Complete ONE (1) Medicare Fax / Mail Cover Sheet for each electronic claim for which documentation is being submitted. This form should not be submitted prior to filing the claim.

Personalized GreenShield claim forms are available online through GSC everywhere. GreenShield's Support Centre. Links to claim forms are available on the HR website. To have a form mailed to you, call the GreenShield Customer Contact Centre at 1-888-711-1119.

The CMS-1500 form is the standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of ...

There are two general billing methods; electronic or paper submission.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232