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Get Bcbs Florida Predetermination Form
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How to fill out the Bcbs Florida Predetermination Form online
The Bcbs Florida Predetermination Form is essential for requesting benefit predetermination or appealing a previous denial. This guide will help you navigate each section of the form efficiently and accurately to ensure a smooth submission process.
Follow the steps to fill out the Bcbs Florida Predetermination Form online
- Click ‘Get Form’ button to obtain the form and open it for editing.
- Begin with the Provider Data section. Enter the date in the format ___/___/____. Fill in the name of the provider or group.
- Specify the rendering physician provider type. If applicable, provide the billing NPI number, ensuring it is 10 digits.
- Indicate the contracting status by selecting either ‘PPO’ or ‘Non-Par’.
- Complete the contact information, including the first and last name of the contact person, their telephone number, and email address.
- Fill in the fax number and the street address, city, state, and zip code for the provider.
- In the Member Data section, enter the member’s identification number (including the alpha prefix) and group number.
- Input the member’s first and last names, followed by the patient’s first and last names.
- Attach any necessary documentation that supports your request. Check all relevant options for the place of treatment and include CPT procedure codes and ICD9 diagnosis codes as needed.
- Review all entered information for accuracy before submitting. Fax the completed form to (800) 852-1360 to ensure it reaches the appropriate department.
Complete your Bcbs Florida Predetermination Form online today for a seamless experience.
Yes, Blue Cross Blue Shield Florida is commonly known as Florida Blue. Both names refer to the same health insurance provider, which offers a range of plans and services. If you need assistance with insurance forms or have questions, consider using USLegalForms. They provide helpful resources to simplify your experience.
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