Get Ehs Claim Submission Form (required For Timely Processing Of ...

This guide provides step-by-step instructions for completing the EHS CLAIM SUBMISSION FORM, ensuring that you can submit your claims correctly and in a timely manner. Follow these instructions to minimize processing delays and help maintain the accuracy of your submission.

Follow the steps to complete your claim submission form successfully.

1. Click ‘Get Form’ button to access the EHS CLAIM SUBMISSION FORM and open it in the appropriate form editor.
2. In section A, provide your subscriber information. Fill in your surname, Green Shield Identification Number, street address, city, province, home and work telephone numbers, email address, postal code, and the name of your employer.
3. Moving on to section B, enter the patient information for each individual involved in the claim. Include the first name, last name, dependant number, and date of birth for each patient, ensuring you only list those with attached receipts.
4. In section C, respond to the mandatory declaration questions. Indicate whether any expenses claimed are covered by another insurance plan. If yes, provide the other member's name and identification number, if applicable. Additionally, specify if any expenses are related to work injuries or motor vehicle accidents by checking the appropriate boxes.
5. In section D, list your claims. For each patient, provide their first name and the name and provider number of the professional or supplier. Also, include the dependant number, date of claim, type of expense, and the total amount charged for each visit or item.
6. Section E requires your authorization. By signing the claim form, confirm that the information is complete and accurate. Sign and date the form as the subscriber.
7. Finally, review section F for mailing instructions. Clearly indicate the appropriate address on the mailing envelope based on the type of claim, and ensure that you attach all original paid receipts, prescriptions, and authorization forms. Retain copies for your records.
8. Once all sections are complete and reviewed, you can save changes, download, print, or share the form as necessary.

Complete your EHS CLAIM SUBMISSION FORM online today to ensure timely processing of your claims!