Get Request For Claim Reconsideration Submit To Claims Bb

This guide provides a comprehensive overview of how to accurately complete the REQUEST FOR CLAIM RECONSIDERATION SUBMIT TO Claims Bb online. It aims to assist users in ensuring all necessary information is provided for a successful reconsideration process.

Follow the steps to complete your claim reconsideration request.

1. Click the ‘Get Form’ button to access the REQUEST FOR CLAIM RECONSIDERATION form and open it in the editor.
2. Begin by filling in the Log# at the top of the form. This should be a unique identifier for your claim that can be referenced later.
3. Complete the PROVIDER NAME field with the name of the healthcare provider submitting the reconsideration request.
4. Enter the DATE PREPARED, which is the date you are filling out the form.
5. Input the TAX ID of the provider to ensure proper identification.
6. Fill in the PERSON COMPLETING FORM section with the name of the individual filling out the document.
7. Provide the HEALTH PLAN PROVIDER # for the relevant health plan.
8. Enter the TELEPHONE # for contact purposes in case further information is needed.
9. Indicate whether you are submitting multiple claims by checking the appropriate box. If this is a single claim, proceed to complete the member information and claim fields.
10. Fill in the MEMBER NAME, DATE OF SERVICE (DOS), MEMBER ID #, and PATIENT ACCOUNT # accurately.
11. Include any PROVIDER COMMENTS if necessary to clarify the request.
12. Enter the CLAIM # related to the reconsideration being requested.
13. Select the REASON FOR CONSIDERATION from the provided options and attach any necessary documentation to support your claim.
14. If applicable, clearly specify any corrections, data changes, or other relevant details in the provided fields.
15. Number of Pages: Indicate how many pages you are submitting with this request.
16. After completing the form, ensure all required fields are filled in, then save changes. You can download, print, or share the completed form as needed.

Complete your documents online accurately and efficiently by following these steps.