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Get Member Claim Form - Health Center - Healthcenter Ucsc
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How to fill out the Member Claim Form - Health Center - Healthcenter Ucsc online
This guide provides a clear and supportive walkthrough for completing the Member Claim Form for Health Center at Healthcenter Ucsc online. By following these steps, users can ensure accurate and timely processing of their health claims.
Follow the steps to accurately complete your claim form.
- Press the ‘Get Form’ button to access the Member Claim Form, and open it in your preferred format.
- Fill out the patient information section. Provide the patient's last name, first name, and middle initial. Ensure you include the patient's birth date, sex, and address details.
- In the subscriber information section, enter the subscriber's name and certificate and group numbers from the Anthem Blue Cross card. Indicate the relationship of the patient to the subscriber by selecting 'Self,' 'Spouse,' or 'Child.'
- Answer whether the patient has other health insurance coverage. If yes, provide the name of the other health insurance company and the policy number.
- Move to the medical information section. Report any covered health services that have not been billed to Anthem by the provider. Attach the required documentation, such as itemized bills.
- Indicate if the medical expense was a result of an accident or if it is job-related. Answer whether you have filed for Workers’ Compensation and provide the date of injury or accident.
- Complete the details for the health care services received, including the date of service, provider's name, type of service rendered, and total cost.
- Sign the form to certify the accuracy of the information provided. Include the date of signing.
- Finally, save your changes, and proceed to download, print, or share the completed form as needed.
Complete your Member Claim Form online today to ensure a seamless claims process.
Cruz Care provides comprehensive health and well-being services for UC Santa Cruz students. It includes a variety of medical and mental health services, allowing students to focus on their studies. To better understand your specific coverage and benefits, please consult your Member Claim Form - Health Center - Healthcenter Ucsc.
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