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Get OR Regence BCBS Form 5266OR 2018-2022

Rs: Fax 1 (855) 232-0085 Administrative Services Only (ASO) members: Fax 1 (844) 679-7763 Mail to: PO Box 1271, WW5-53, Portland, OR 97207-127 Used for skilled nursing (SNF), long term acute care (LTAC), inpatient rehabilitation (IP Rehab), behavioral health services, and medical services including; inpatient and outpatient surgeries, outpatient medical services, transplants, DME and professional services. Instructions: This form should be filled out by the provider requesting the service or.

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