What is reimbursement claim process?

Reimbursement Claim refers to the type of claim wherein an insured must pay for the medical costs and treatment out of their pocket and later claim the bill from the insurance provider. For this kind of claim, the insured can visit any hospital for treatment and not necessarily the empanelled cashless hospital.

Where do I send my Blue Shield of California claim?

Dedicated Provider appeals line: Phone:(800) 541-6652. HMO and PPO: Blue Shield of California Initial Appeal Resolution Office. P.O. Box 272620. Chico, CA 95927-2620. Blue Shield 65 Plus (HMO): Blue Shield 65 Plus. Medicare Provider Appeals Department. P.O. Box 272640. Chico, CA 95927-2640. Fax: (855) 895-3501.

How do I get reimbursed by Medi Cal?

To file a claim, you must submit a Medi-Cal Claim Form for Beneficiary Reimbursement. The claim form must be filled out in blue or black ink; The claim form must have an original signature (no copies will be accepted); The Claim Form must include: A photo copy of your Medi-Cal Beneficiary Identification Card (BIC).

What is the purpose of submitting a claim form for reimbursement?

Filing a health insurance claim means you're requesting reimbursement or direct payment for medical services that you've already received. The way to obtain benefits or payment is by submitting a claim via a specific form or request.

What is the first step in completing a claim form?

What is the first step in completing a claim form? Check for a photocopy of the patient's insurance card.

Who is the subscriber on a claim form?

The person who pays for health insurance premiums or whose employment is the basis for membership in the insurance plan. For example, if you have health insurance through your spouse's health insurance plan, he or she is the primary subscriber.

How do I fill out a reimbursement claim form?

How to Fill Care Health Insurance Claim Reimbursement Form Step 1: Fill Out the Details of the Primary Insured. ... Step 2: Disclose the Insurance History of the Person Filing Claim. ... Step 3: List Down the Details of the Insured Person Hospitalized. ... Step 4: Enter the Hospitalization Information.

How to submit a reimbursement claim to Blue Shield of California?

Claims should be submitted to Blue Shield of California via the Real-Time Claims web tool or electronically using Electronic Data Interchange, though they can also be submitted by mail.

Get Subscriber Statement Form

Q: What is the purpose of submitting a claim form for reimbursement?

Filing a health insurance claim means you&#039;re requesting reimbursement or direct payment for medical services that you&#039;ve already received. The way to obtain benefits or payment is by submitting a claim via a specific form or request.

SUBSCRIBER S STATEMENT OF CLAIM IMPORTANT INSTRUCTIONS This form is to be used ONLY when the Provider of Service does not submit your claim directly to Blue Shield. Check with the Provider to be sure no claim has been submitted* Duplicate claims will not only be rejected but may delay payment of the original claim* EXCEPTIONS USE A SEPARATE FORM FOR A. EACH MEMBER OF THE FAMILY PRIMARY MEDICARE COVERAGE A. Submit claim to Medicare first. B. Complete Boxes 1 and 4 only. C. Attach your Explanation of Medicare Benefits form and a copy of itemized services to this claim and send all to Blue Shield. FOREIGN CLAIMS Any services rendered outside of the United States or its territories must include the US currency exchange rate or value and the translation for all billed services. B. EACH DIFFERENT PROVIDER OF SERVICE C. EACH ITEMIZED BILL PRINT OR TYPE FILL IN ALL ITEMS COMPLETELY SIGN YOUR NAME IN THE SPACE PROVIDED Failure to comply with these instructions may result in your claim being delayed or returned to you. SUBSCRIBER NAME LAST NAME FIRST MI MAIL ADDRESS STREET GROUP NUMBER CITY STATE ZIP CODE IS ADDRESS NEW YES DATE OF BIRTH Month Day NAME OF PATIENT LAST NAME FIRST NAME MIDDLE INITIAL PATIENT S SEX NO RELATIONSHIP TO SUBSCRIBER Year Male Female Self Spouse Child DESCRIBE BRIEFLY PATIENT S ILLNESS OR INJURY AND IF INJURY HOW IT OCCURRED PATIENT WAS TREATED FOR INJURY DATE OF INJURY ONSET OF ILLNESS OR PREGNANCY ILLNESS DOES PATIENT HAVE OTHER HEALTH COVERAGE IS PATIENT RETIRED IF YES POLICY IDENTIFICATION NO. If Yes EFFECTIVE DATE NAME OF INSURING COMPANY TYPE OF PLAN ADDRESS OF INSURING COMPANY GROUP NAME OF POLICY HOLDER WAS CONDITION RELATED TO EMPLOYMENT SEX INDIVIDUAL NAME OF EMPLOYER PATIENT S DATE OF BIRTH PART A EFFECTIVE DATE SUBSCRIBER S SIGNATURE I certify that the foregoing information is accurate and complete and authorize the release of any medical information necessary to process this claim* X DATE SEND THIS CLAIM TO CLM-14850 8/02 BLUE SHIELD OF CALIFORNIA P. Check with the Provider to be sure no claim has been submitted* Duplicate claims will not only be rejected but may delay payment of the original claim* EXCEPTIONS USE A SEPARATE FORM FOR A. EACH MEMBER OF THE FAMILY PRIMARY MEDICARE COVERAGE A. Submit claim to Medicare first. B. Complete Boxes 1 and 4 only. EACH MEMBER OF THE FAMILY PRIMARY MEDICARE COVERAGE A. Submit claim to Medicare first. B. Complete Boxes 1 and 4 only. C. Attach your Explanation of Medicare Benefits form and a copy of itemized services to this claim and send all to Blue Shield. C. Attach your Explanation of Medicare Benefits form and a copy of itemized services to this claim and send all to Blue Shield. FOREIGN CLAIMS Any services rendered outside of the United States or its territories must include the US currency exchange rate or value and the translation for all billed services. FOREIGN CLAIMS Any services rendered outside of the United States or its territories must include the US currency exchange rate or value and the translation for all billed services. B. EACH DIFFERENT PROVIDER OF SERVICE C. EACH ITEMIZED BILL PRINT OR TYPE FILL IN ALL ITEMS COMPLETELY SIGN YOUR NAME IN THE SPACE PROVIDED Failure to comply with these instructions may result in your claim being delayed or returned to you.

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