Get Mpiphp Forms

Filling out the Mpiphp Forms online can streamline the claims process and ensure that your submission is accurate. This guide provides step-by-step instructions to help you complete each section of the form with confidence.

Follow the steps to successfully complete the Mpiphp Forms online.

1. Click the ‘Get Form’ button to access the Mpiphp Forms. This action will open the form for you to fill out in your preferred editing platform.
2. Begin with Section A, where you will need to enter the patient information. Include the patient's last name, first name, middle initial, coverage details, relation to the policy subscriber, gender, employer name, and group number.
3. Proceed to Section B, which requires subscriber information. Fill in the identification number from your Anthem Blue Cross card, along with the subscriber's last name, first name, middle initial, date of birth, policy number, and contact details such as street address, city, state, ZIP code, and phone numbers.
4. Move on to Section C for medical information. Here, list the health care services provided, including relevant diagnosis codes and procedure codes. Confirm whether the medical expenses were due to an accident, if the injury was job-related, and if you have filed for Workers’ Compensation.
5. Ensure that the bills you include are itemized. Each bill must feature the provider's name and address, the patient’s name, services rendered, service dates, amounts charged, diagnosis codes, procedure codes, and the provider's tax ID.
6. At the bottom of the form, provide your name, date, and signature to certify the information is true and correct and to authorize the release of any necessary medical information.
7. Once you have completed all sections, review the form for accuracy. You can then save your changes, download the completed form, print it for your records, or share it if necessary.

Complete your Mpiphp Forms online now to ensure quick and accurate processing of your claims.