Get Bcbsmcomsubrogation Form

Filling out the Bcbsmcomsubrogation Form is an important step in processing your claim. This guide will provide you with clear, step-by-step instructions to help you complete the form online efficiently and accurately.

Follow the steps to successfully complete the Bcbsmcomsubrogation Form.

1. Click ‘Get Form’ button to obtain the form and open it in your chosen editor.
2. Enter the date at the top of the form to indicate when you are submitting it.
3. Fill in the patient’s name. Ensure accuracy to avoid any delays in processing.
4. Provide the patient’s date of birth in the designated field.
5. Locate the contract number, which is a 9-digit number found on the BCBSM card, and enter it in the corresponding box.
6. If applicable, provide the name of the spouse if they are on the BCBSM policy.
7. Fill in the BCBSM policy holder's name if it differs from the patient's name.
8. Input the date of birth of the policy holder in the appropriate field.
9. Enter your phone number for contact purposes.
10. Select the type of case from the options provided, such as personal injury or motor vehicle accident.
11. Specify the state where the incident occurred.
12. Indicate whether a vehicle was involved in the incident by selecting yes or no.
13. If known, provide information about the court or workers' compensation bureau related to the case.
14. Fill in the date of injury.
15. Describe the type of injury and the area of the body that was affected.
16. If you have hired an attorney, provide their name, law firm name, street address, city, phone number, state, zip code, and fax number.
17. List the insurance company's name and the insurance adjuster's name.
18. Enter the insurance claim number and the insurance company’s street address.
19. Fill in the insurance adjuster's phone number and fax number.
20. Provide the date and type of the next scheduled hearing date.
21. After completing all fields, review the form for accuracy. Then, save your changes, download, print, or share the filled form as needed.

Complete your documents online today for efficient submission!