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  • Carefirst Health Benefits Claim Form Fillable

Get Carefirst Health Benefits Claim Form Fillable

HEALTH BENEFITS CLAIM FORM PLEASE TYPE OR PRINT 1. ID# / SOCIAL SECURITY # PLEASE COMPLETE A SEPARATE CLAIM FORM FOR EACH FAMILY MEMBER. (SEE REVERSE SIDE FOR FILING INFORMATION) PLEASE COMPLETE EACH.

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Call 1-800-200-4255(TTY: 711).

Submit the request in one of the following ways: via fax to 443-552-7407 / 443-552-7408.

Frequency code 8: • Must be used to fully void a claim. Must represent the entire claim—not just the line or item that you are retracting.

Electronically (preferred method) through our Clearinghouse, Change Healthcare (formerly Emdeon) – Payor ID 45281.

Common Re-Submission Codes Include: 6-Corrected. 7-Replacement. 8-Void.

Mailing Address (claims and correspondence): Blue Benefit Administrators of Massachusetts. PO BOX 55917. Boston, MA 02205-5917.

Filing claims Use payor ID 03036 to submit claims electronically. Call your clearinghouse or Change Healthcare at 1-800-266-2206 for help submitting claims.

All claims for services rendered must be submitted within 365 days from the date of service or discharge date for inpatient admissions.

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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