Loading
Get Bcbs Florida Predetermination Form
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
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 of Florida is synonymous with Florida Blue. This name change reflects a commitment to serving the community more effectively. If you are looking to manage your healthcare processes, utilizing tools like the Bcbs Florida Predetermination Form can help you secure necessary approvals and access to services.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.