Get Medicare Advantage Member Application For Payment Consideration

Filling out the Medicare Advantage Member Application For Payment Consideration online is a crucial step in securing payment for your healthcare services. This guide will provide you with detailed, step-by-step instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to successfully complete your application online.

1. Press the ‘Get Form’ button to access the application form and open it for completion.
2. Begin by entering your last name in the designated field for member's last name.
3. Next, fill in your first name in the member's first name field.
4. Input your alpha/numeric contract number as stated on your BCBSM ID card.
5. Provide your street address, city, state, and zip code in the respective fields.
6. Enter your date of birth in the prescribed format.
7. Indicate whether the claim was work-related, and if it pertains to an auto accident, check 'yes' or 'no' as appropriate.
8. If applicable, include the date of injury or illness in the provided section.
9. Select your sex by marking either 'M' for male or 'F' for female.
10. If you have other health insurance, specify the name of that insurance and the policy number in the relevant fields.
11. Review your entries for accuracy and re-confirm that all information is true and unaltered before signing.
12. Provide your signature and the date on which you are completing the form.
13. Conclude by making sure all required original receipts are included before submitting the form. Remember to make copies of all documents for your records.
14. Finally, save your changes, download the completed form, or print it for mailing.

Take action now and complete your Medicare Advantage Member Application For Payment Consideration form online to ensure timely processing.