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Get Beacon Health Strategies 60 Day Waiver Form Pdf 2020-2025
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How to fill out the Beacon Health Strategies 60 Day Waiver Form Pdf online
Filling out the Beacon Health Strategies 60 Day Waiver Form Pdf online can be a straightforward process with the right guidance. This comprehensive guide will walk you through each section of the form to ensure your submission is accurate and complete.
Follow the steps to complete the form correctly.
- Click the ‘Get Form’ button to obtain the form and open it in your chosen editor.
- Begin by entering the demographic information in Section I. Fill in the provider name, Beacon provider ID number, member name, member ID number, contact person, and telephone number.
- Move to Section II to provide the reason(s) for the waiver. Review the list of valid reasons for requesting a 60 Day Waiver and check all that apply. If you are claiming third-party coverage, be sure to attach a copy of the Explanation of Benefits (EOB).
- Certify the claim by stating that it is true and correct. Ensure you include your signature as the provider and add the date of signing.
- In Section III, leave the fields for Beacon use only blank. This section is reserved for internal processing.
- Once all fields are completed, save the changes made to the form. You may download it, print it for physical records, or share it directly as needed.
Start completing your forms online today!
Beacon Health Options will operate as a wholly-owned subsidiary of Anthem and its associates will join Anthem's Diversified Business Group .
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