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Clear data PRIOR AUTHORIZATION PHYSICIAN FAX FORM PLEASE USE THIS FORM IF YOUR PRACTICE PURCHASES AND BILLS BCBSKS Only the prescriber may complete this form. The following documentation is REQUIRED.

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SYNA Related content

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Blue Cross Blue Shield of Minnesota, 3535 Blue Cross Rd, Eagan, MN, Community Services - MapQuest.

If you had a BCBSTX plan through the Marketplace, the Marketplace sends you a 1095-A form. Log in to your online Marketplace account or call 800-318-2596 (TTY: 855-889-4325) to ask for a copy of the 1095-A.

Most Blue Cross Blue Shield members can rest easy since Blue Cross Blue Shield coverage opens doors in all 50 states and is accepted by over 90 percent of doctors and specialists.

If you do not receive your Form 1095-B by mid-March, or if you lose it, you can call your medical insurance provider toll-free to ask for another copy: Blue Cross and Blue Shield of Texas: (800) 252-8039 (TTY: 711), 7 a.m. – 7 p.m. CT Monday – Friday, 7 a.m. – 3 p.m. CT Saturday.

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.

Call the number listed on your BCBSTX member ID card to ask for your Form 1095-B to be mailed to your address on file within 30 days. If you can't find this number, you can also call 1-855-710-6984. Once this form is received, your Form 1095-B will be mailed to your address on file within 30 days.

Provider payer ID is 00562. The payer name for Blue Cross is: BCBSMN BLUE PLUS MEDICAID.

The person who pays for health insurance premiums or whose employment is the basis for membership in the insurance plan. For example, if you have health insurance through your spouse's health insurance plan, he or she is the primary subscriber.

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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