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Get Blue Cross Blue Shield Of Illinois Predetermination Forms
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How to fill out the Blue Cross Blue Shield Of Illinois Predetermination Forms online
This guide provides clear and step-by-step instructions on how to fill out the Blue Cross Blue Shield Of Illinois Predetermination Forms online. By following these directions, users can ensure their requests for services are accurately processed.
Follow the steps to complete the online form successfully.
- Click the ‘Get Form’ button to access the Predetermination Request Form and open it for editing.
- Begin by entering the provider data. Include the date, name of the provider or group, rendering physician provider type, billing NPI number if applicable, and contracting status. Also, provide an email address, contact person’s first and last names, their telephone number, fax number, street address, city, state, and zip code.
- Next, fill in the member data. Input the member identification number (including the alpha prefix), group number, patient’s date of birth, and both the member’s and patient’s first and last names.
- Attach any documentation that supports your request for review, ensuring that you check all applicable boxes related to the place of treatment, health history, therapy notes, procedure codes, and diagnosis codes.
- After filling out all required fields, confirm the completeness of all entered information to avoid delays. Ensure to provide procedural details such as left, right, or bilateral indications if applicable.
- Submit the form by faxing it to the indicated number, ensuring to fax information for each patient separately. If necessary, you may also opt to mail the completed form to the designated address.
- Finally, save any changes made to the form. Users can also download, print, or share the filled-out form as needed for their records.
Ensure your requests are processed efficiently by filling out the necessary documents online today.
When submitting claims to Blue Cross Blue Shield of Illinois, it's essential to know the correct address. Claims can typically be sent to the address listed on your member ID card or the claims processing section of their website. Make sure to keep a record of your submission for future reference and follow up as necessary.
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