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Get 1 Of 8 Claim Form And Instructions For The Anthem ...
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How to fill out the 1 Of 8 CLAIM FORM AND INSTRUCTIONS FOR THE ANTHEM online
Filling out the Claim Form for the Anthem Settlement Fund can be a straightforward process with the right guidance. This guide aims to walk you through each section of the form to ensure you complete it correctly and efficiently.
Follow the steps to successfully fill out your claim form.
- Press the ‘Get Form’ button to access the Claim Form and open it in your chosen editing tool.
- Begin with Section A if you are a dentist submitting your claim. Ensure you read the notice of proposed settlement beforehand. Declare and certify your status, including your name, contact information, and signature.
- Select only one of the provided options regarding your participation period with Anthem. Check the box that reflects your situation—either for the entire period or for part of it.
- Provide the name, Tax Identification Number, and dates of participation for the entity or person you contracted with under Anthem during the designated period. You may list up to three entities here. If needed, attach an additional sheet.
- Complete the Substitute W-9 form by entering the appropriate Social Security Number or Tax Identification Number, ensuring all certifications regarding backup withholding are accurate.
- If you are a provider group or organization submitting on behalf of an individual settlement class member, use Section B. Confirm your authority, list member details, and indicate the participation period as per Step 3.
- After filling out all necessary fields and sections, review the entire form for accuracy. Once satisfied, save changes, print, or download a copy for your records.
- Finally, mail the completed Claim Form to the designated Settlement Administrator’s address, ensuring it is postmarked by the submission deadline.
Complete your claim form online today to ensure your submission is processed promptly.
Making a claim using the 1 Of 8 CLAIM FORM AND INSTRUCTIONS FOR THE ANTHEM follows a simple process. First, gather essential documents such as your policy and any supporting evidence. Next, carefully complete the form, and finally, submit the claim to your insurance provider either online or via mail, ensuring you keep a copy for your records.
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