Get Excellus Subscriber Claim Form Fax Number

This guide provides a clear and systematic approach to completing the Excellus Subscriber Claim Form Fax Number online. By following the steps outlined, users can ensure that they accurately provide the necessary information to process their claims efficiently.

Follow the steps to successfully complete the claims form.

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin by filling out the subscriber identification number. Include the ID prefix as reflected on your insurance card.
3. Provide the subscriber's full name in the designated field, ensuring it matches official documents.
4. In the patient information section, enter the patient's full name, sex, address, city, state, and zip code accurately.
5. Indicate the patient's date of birth and relationship to the subscriber (self, spouse, child, or college student).
6. If applicable, state the date of injury or illness and specify the country where treatment was received, if other than the USA.
7. Enter the patient diagnosis that required treatment, clearly outlining the medical condition.
8. Check the box if you want payment to be made directly to the provider, understanding the eligibility criteria.
9. If the patient is covered by Medicare, ensure to send the appropriate bills along with an Explanation of Medicare Benefit.
10. For motor vehicle or work-related illnesses or injuries, answer the corresponding questions and provide details if necessary.
11. If the patient is covered by another insurance plan, complete the other insurance carrier section thoroughly, including the policyholder's information.
12. Finally, sign and date the form in the claim date and subscriber signature section. Ensure the form is completely filled out to avoid delays.
13. Once all information is entered, save your changes, and then choose to download, print, or share the completed form as needed.

Complete your Excellus Subscriber Claim Form online today for prompt processing of your claims.