Get Mn Bcbs F1224r20 2009-2025

Completing the MN BCBS F1224R20 is an essential step in submitting your prescription drug claim efficiently. This guide provides detailed instructions to help you fill out the form accurately and submit your claim online.

Follow the steps to complete your claim form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the identification information at the top of the form, including your subscriber identification number, group number, and names of the subscriber and patient. Make sure to use black ink if you're filling it physically and ensure clarity while typing.
3. Indicate the patient's birth date and sex, selecting from the provided options. Specify the patient's relationship to the subscriber by checking the appropriate box.
4. Provide the subscriber's address, including street, city, state, and zip code. Ensure that this information is accurate, as it will be used for communication regarding your claim.
5. Answer whether the patient's condition is job-related by checking 'Yes' or 'No.'
6. If the patient has other insurance coverage, indicate this by checking 'Yes' and provide the insurance carrier's name and address, along with the identification number.
7. List the pharmacy's name and address, filling in all necessary details. This ensures that your claim is connected with the correct pharmacy.
8. In the prescription details section, list each prescription received. Include the purchase date, Rx number, name of the drug, manufacturer's name, dosage form and strength, quantity, and total charge for each medication.
9. A pharmacist's signature is mandatory for each prescription listed unless a receipt or printout is attached. Ensure all receipts are properly attached if you prefer not to obtain a signature.
10. Calculate the grand total for all medications listed and write it in the designated area of the form.
11. Finally, review all entries for accuracy before saving your changes, downloading your completed form, printing it out for submission, or sharing it if needed.

Prepare your MN BCBS F1224R20 form online for a smooth and efficient claim submission.