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  • Carefirst Bcbs Cut0166-1s 2014

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St Name) 4. PATIENT S OTHER INSURANCE INFORMATION 5. PATIENT S SEX 6. SUBSCRIBER S ID NUMBER MALE q IS PATIENT COVERED UNDER OTHER INSURANCE? YES q NO q IF YES, NAME OF INSURANCE CO. IS PATIENT COVERED UNDER MEDICARE? YES q IF YES, PART A q FEMALE q 7. RELATIONSHIP TO SUBSCRIBER 8. SUBSCRIBER S GROUP NUMBER OR ENROLLMENT CODE SELF q SPOUSE q CHILD q OTHER q NO q 9. WAS CONDITION DUE TO: PART B q WORK? YES q NAME OF POLICY HOLDER (INCLUDING MEDICARE) STREET AUTO ACCIDENT.

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How to fill out the CareFirst BCBS CUT0166-1S online

Filling out the CareFirst BCBS CUT0166-1S form is essential for submitting your vision or eye care claims. This guide will provide clear and detailed instructions to help you navigate the process of completing the form online.

Follow the steps to successfully fill out the CareFirst BCBS CUT0166-1S form.

  1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
  2. Begin by entering the patient’s name in the first field. Make sure to provide the first name, middle initial, and last name accurately.
  3. Next, fill in the patient’s date of birth. Ensure the date format is consistent and correct.
  4. Enter the subscriber’s name, similar to how you entered the patient's name, including first name, middle initial, and last name.
  5. Provide any additional insurance information related to the patient in the specified field.
  6. Select the patient's sex by checking either 'Male' or 'Female'.
  7. Input the subscriber’s ID number as it appears on their identification card.
  8. Indicate if the patient is covered under other insurance by checking 'Yes' or 'No', and if yes, provide the name of the insurance company.
  9. Indicate if the patient is covered under Medicare and specify which part (A or B) as applicable.
  10. Fill in the subscriber’s relationship to the patient by choosing from the options provided: 'Self', 'Spouse', 'Child', or 'Other'.
  11. Provide the subscriber’s group number or enrollment code from the identification card.
  12. In the next section, specify if the condition was due to work or an auto accident, checking 'Yes' or 'No' as appropriate.
  13. Enter the subscriber’s address, including street, city, state, and zip code.
  14. Sign the form to certify that the information provided is correct and authorize the release of any necessary medical information.
  15. Input the daytime telephone number of the subscriber.
  16. Complete the authorization for assignment of benefits section, including the provider’s information and signature, if applicable.
  17. Ensure the provider completes items 13 through 36 as required, detailing diagnostic codes, date of service, and charges.
  18. Once all sections are filled, review the form for accuracy before saving changes, downloading, printing, or sharing as needed.

Complete your vision or eye care claims online today!

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BCBS of Maryland operates under the CareFirst name, which means they are essentially the same entity. CareFirst BCBS CUT0166-1S represents one of the key products and services offered by this organization. If you are looking for coverage options or more information about CareFirst, the US Legal Forms platform can guide you through the details of your insurance needs.

Payer ID SB580 is linked to a specific health plan provider, but it does not represent CareFirst BCBS CUT0166-1S. Each payer ID is unique to its respective insurer, so it's essential to verify its affiliation with your specific provider network. You can find help with such inquiries on the US Legal Forms platform, which offers resources to clarify payer ID information.

The payer ID 13292 is commonly associated with CareFirst BCBS services. It's crucial to utilize this payer ID correctly when submitting claims to streamline your reimbursement process. If you need further details about this payer ID, you can refer to official CareFirst resources or consult the US Legal Forms platform for additional support.

The payer ID code 58066 typically refers to a health insurer, which may not be directly related to CareFirst BCBS CUT0166-1S. It's important to confirm the specific insurer associated with this ID to ensure accurate claim submissions. Always double-check the payer ID with the resources you have. For comprehensive assistance, the US Legal Forms platform can help clarify payer ID inquiries.

The payer ID for CareFirst BCBS CUT0166-1S is essential for your claims to process smoothly. You can find this ID on CareFirst's official website or through your provider services. Using the correct payer ID helps avoid delays in payment and ensures a faster reimbursement process. For more information, consider visiting the US Legal Forms platform.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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
CareFirst BCBS CUT0166-1S
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