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  • Designation Of An Authorized Representative - Highmark Blue Shield

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Designation of an Authorized Representative This Section To be completed by the Customer Service Representative Only To: (check one) Member Grievance and Appeals P.O. Box 2717 Pittsburgh, PA 152302717.

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In addition, you or your representative have the right to give additional information in person at the time of the appeal hearing, in writing, by phone, or by fax to 1-833-841-8074.

Providers in need of assistance should contact provider services at 800-241-5704 (toll-free).

You should send your written grievance to: Medicare Prescription Drug Appeals Department PO Box 535047 Pittsburgh, PA 15253-5047 or Fax your request to: Medicare Appeals Department 412-544-1513 Whether you file your grievance orally or in writing, will respond to your complaint within 30 days or as quickly as the case ...

The member ID prefixes associated with the BlueDental plans are: 99D. MUM.

The alpha prefix for Highmark FreedomBlue members is HKS or FEM for enrollment source Plan Code 363 and HKR or FER for enrollment source Plan Code 378.

The home plan can be identified by the [typically] 3 character alpha prefix on the patient's insurance card.

Return the completed Claim Form to: Highmark Blue Cross Blue Shield, the Claims Administrator for the medical component of the Plan, at the following address: Highmark Blue Cross Blue Shield P. O. Box 1210 Pittsburgh, PA 15230-1210 • Attach: all original itemized bills to the claim form.

What BCBS plan starts with Xxp? By now, you should have received your new BCBS member ID card(s) your subscriber ID beginning with the 3-letter prefix 'XXP' indicating the PPO Deductible Plan.

Return the completed Claim Form to: Highmark Blue Cross Blue Shield, the Claims Administrator for the medical component of the Plan, at the following address: Highmark Blue Cross Blue Shield P. O. Box 1210 Pittsburgh, PA 15230-1210 • Attach: all original itemized bills to the claim form.

Highmark Blue Cross Blue Shield.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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 workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
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