Get Provider Correspondence Form - Blue Cross & Blue Shield Of ...
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 Provider Correspondence Form - Blue Cross & Blue Shield Of ... online
Filling out the Provider Correspondence Form accurately is essential for ensuring that your requests are processed promptly. This guide provides step-by-step instructions to help you complete the form successfully online.
Follow the steps to complete the Provider Correspondence Form online
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Fill out Section A: Patient Information. Ensure that all fields are completed, including the member's insurance, date of birth, patient name, subscriber ID number, date of service, patient account number, claim number, and total charge. If more than one claim is involved, list additional claim details on a separate sheet and attach it.
- Complete Section B: Provider Information. All fields must be filled out, including your BCBS provider number, provider name, provider address, tax ID number, contact name and title, NPI number, contact address, and telephone number with extension.
- In Section C: Submission of Requested Medical Documentation, indicate if you received an EDI Error 318 and if medical records are requested. Attach a copy of the request letter and any additional details and documentation as needed.
- Review all entered information for accuracy and completeness, as incomplete forms cannot be processed.
- Once the form is complete, save your changes. You can choose to download, print, or share the form according to your needs.
Start filling out your documents online today for efficient processing.
Call Blue Cross & Blue Shield of Mississippi at 800-709-7881 or visit their website at .BCBSMS.com.
Fill Provider Correspondence Form - Blue Cross & Blue Shield Of ...
Out of State BCBS Plan. Mail this form, a listing of claims (if applicable) and supporting documentation to: Claim Correspondence. Anthem Blue Cross and Blue Shield. Here are some of the common documents and forms you may need in order to treat our members and do business with us. They are designed to help you streamline billing and evaluate costs. Use this form to grant Blue Cross and Blue Shield of Massachusetts permission to make a single disclosure of specific information to a specific person. You may use this form to appeal multiple dates of service for the same member. This page offers quick access to the forms you use most. Looking for a form that isn't listed? Listed below are the updated correspondence and appeal addresses.
Industry-leading security and compliance
-
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.