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  • Alternative Care Claim Form For Providers - Providence Health ... - Healthplans Providence

Get Alternative Care Claim Form For Providers - Providence Health ... - Healthplans Providence

Ll not submit a claim, you can use this claim form for any alternative care reimbursement requests you may have. Your provider can help you complete this form or provide an itemized bill with the information we need to process your claim. Itemized bills must include the: Date of service Name, address, tax identification number, national provider index ("NPI") number and address of the physician or other medical provider who provided the service Diagnosis and procedure code(s) an.

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How to use or fill out the Alternative Care Claim Form For Providers - Providence Health online

Filling out the Alternative Care Claim Form for providers requires attention to detail and accurate information. This guide will walk you through the process step-by-step to ensure your claim for alternative care services is submitted correctly.

Follow the steps to complete the form accurately.

  1. Click ‘Get Form’ button to obtain the claim form and open it for editing. This allows you to begin the process of filling out the required information.
  2. Provide patient and subscriber information. Enter the patient's full name, birth date, and sex. Include the member ID number, address, and the subscriber's details, including their name, group number, and address.
  3. Detail the services received. In this section, list each date of service individually. For each entry, include the procedure code, any applicable modifiers, the number of units, and the charges associated with each service.
  4. Complete the rendering provider's information. Enter the full name, address, ZIP code, and phone number of the provider who rendered the services.
  5. Provide the facility's information where the services were rendered. Fill in the facility name and address, as well as the tax identification number and NPI number for verification.
  6. Attach the required documentation. Include an itemized bill with a proof of purchase or payment receipt alongside the completed form.
  7. Submit the claim. Send the form and the attached documents to Providence Health Plans at the specified address. Ensure your submission is within the allowed time frames for claim processing.
  8. Finally, save your changes, download, print, or share the completed form as needed for your records.

Complete your claims quickly and accurately by following these steps to fill out the Alternative Care Claim Form online.

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To fill out the Alternative Care Claim Form for Providers - Providence Health ... - Healthplans Providence, start by entering your personal details, including your name, address, and insurance policy number. Ensure you provide specific information about the treatment or services received, including the dates and costs. You should double-check for accuracy to avoid delays in processing your claim. Using clear and concise information will help streamline the process.

For providers looking to submit health insurance claims, the appropriate form is the Alternative Care Claim Form For Providers - Providence Health ... - Healthplans Providence. This form captures essential information, ensuring efficient processing of claims. It's vital to complete this form accurately to avoid delays in claim approval. If you require assistance, uslegalforms offers resources that guide you through the process of filling out claims effectively.

The compensation of the CEO of Providence Hospital can vary significantly based on several factors, including hospital performance and regional salaries. For accurate financial details, you may want to check annual reports or financial disclosures. Inquiries regarding staff and administration can often relate to the overall service quality, including how efficiently the Alternative Care Claim Form for Providers - Providence Health - Healthplans Providence is handled.

The decision for Aetna to drop Providence in Oregon stemmed from contract disputes over reimbursement rates and network participation. This shift impacts many patients in the state who relied on services provided by both organizations. Understanding these changes is crucial, especially when managing your Alternative Care Claim Form for Providers - Providence Health - Healthplans Providence.

To submit your own health insurance claim, you first need to gather all relevant documents, including your invoice and any supporting medical records. Next, fill out the Alternative Care Claim Form for Providers - Providence Health - Healthplans Providence. Once completed, submit the form and your documents to your insurance provider as per their submission guidelines.

We are Health Share The Oregon Health Plan (OHP) is our state's Medicaid program. It provides no-cost health coverage—including medical, dental and mental health and substance use benefits—to individuals and families who qualify.

Our Family of Plans Our network gives you access to more great care through Health Share. You can choose between CareOregon, Kaiser Permanente, Legacy Health PacificSource, OHSU Health, and Providence Health Assurance.

The Oregon Health Plan (OHP) is Oregon's Medicaid and Children's Health Insurance Program. It provides health care coverage for Oregonians from all walks of life. This includes working families, children, pregnant adults, single adults and seniors.

If you need to report a claim with us, you may call us at 1-877-763-1800, complete the form below or contact your Providence Mutual agent. A Providence Mutual Claims Representative will contact you and assist you through the claims process.

For all services you get outside Oregon, the provider must accept OHP. If the provider does not accept OHP, you must pay for the services. If you need services outside Oregon: In an emergency, make sure the hospital knows you are an OHP member.

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© Copyright 1997-2025
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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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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