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  • Bcbs Florida Predetermination Form

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2. An appeal of a previously denied predetermination of benefits. Please include all required information, such as Provider information, Patient information and specific information for the services in question. Please note: Inquires received without the member/patient s group and ID number cannot be completed and may be returned to you to supply this information. It is important that all fields on the form be completed. If all information is not provided, this may cause a delay in the prede.

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Use a separate form for each family member and each physician or supplier. Enclose ORIGINAL itemized bills. Keep a copy for your records. • Mail to: Blue Cross and Blue Shield of Florida, PO Box 1798, Jacksonville, FL 32231-0014 see previous page for more instructions.

Or call the Customer Service number on your member ID card or 1-800-FLA-BLUE (352-2583) to request additional cards.

If you have Florida Blue patients who could benefit from care management assistance at no additional cost to them, let us know by completing this Clinical Care Programs referral form or call us at 844-730-2583 (844-730-BLUE).

24-hour member self-service For coverage approval status, copies of forms and more, sign in to your account or call our Automated Assistant at 1-800-352-2583 anytime, day or night.

How to find your 1095-A online Log in to your HealthCare.gov account. Under "Your Existing Applications," select your 2022 application — not your 2023 application. Select “Tax Forms” from the menu on the left. Download all 1095-As shown on the screen.

Your doctor must contact Florida Blue at 1-877-719-2583 or its delegate at (800) 424-4947 at MagellanRx Management.

NOTE: Fax Expedited Review Requests to 1-904-565-6637 to ensure immediate receipt.

You are solely responsible for getting any required authorization before services are rendered, regardless of whether you go to an in- or out-of-network health care provider. An in-network health care provider will request a prior authorization on your behalf.

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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
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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 workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
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