Get Blue Cross Of Alabama Fillable Form Cl 94

Filling out the Blue Cross Of Alabama Fillable Form Cl 94 online is a straightforward process that allows users to claim eligible medical expenses quickly. This guide provides step-by-step instructions to assist you in completing the form accurately and efficiently.

Follow the steps to complete your claim form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient’s name in the appropriate fields, ensuring that only one patient’s details are filled out per form.
3. Next, locate the contract number as shown on the patient's I.D. card and input it into the designated field.
4. Enter the group number as shown on the I.D. card or place of employment, including any letters if applicable.
5. Fill in the patient's date of birth in the provided format, ensuring accuracy.
6. Indicate the patient’s sex by selecting the appropriate option, either Male or Female.
7. Specify the patient's relationship to the contract holder by selecting from the options provided: Self, Child, Spouse, or Other.
8. Input the contract holder's information as per the details shown on the I.D. card, including their name, address, and daytime telephone number.
9. Answer whether the patient is covered under any other group health insurance plan by selecting Yes or No. If Yes, provide the name of the policy holder and insuring company.
10. Answer if the condition was related to employment, an auto accident, or another accident/injury, and provide any necessary details.
11. Detail the diagnoses, including the type of illness or injury neatly in the respective section.
12. Enter the details of the ordering physician along with their contact number and address.
13. Attach the original bill or statement from the physician or supplier and keep a copy for your records while ensuring that the bill contains all required information.
14. Sign the form to certify that the information provided is true and correct and that the expenses were incurred by the patient.
15. After completing the form, you can save changes, download, print, or share the form as needed.

Begin filling out your claim for eligible medical expenses online today.