Get Bmc Pdffilter

Filling out the Bmc Pdffilter online is an essential step for non-participating providers looking to activate their status with Boston Medical Center HealthNet Plan. This guide offers detailed instructions to help users complete the form accurately and efficiently.

Follow the steps to efficiently complete the Bmc Pdffilter form.

1. Click ‘Get Form’ button to access the Bmc Pdffilter document and open it for editing.
2. Enter the 'Date of Request' in the designated field, ensuring it reflects the current date.
3. Fill in the 'Referral/Auth. #' field to provide relevant referral or authorization numbers.
4. Input your name in the 'Requested By' section, followed by your 'Department' title.
5. Provide the 'Member Name' and 'BMCHP Member #' for proper identification of the plan member.
6. In the 'PROVIDER INFORMATION' section, complete all applicable fields, including 'Practitioner Entity', 'Facility', and 'Group'.
7. Fill out the provider's personal information such as 'Provider Name', 'Provider NPI #', 'Provider Title', 'Provider's SSN', 'License #', and 'Provider's DOB'.
8. Include a valid 'E-Mail Address' to receive notifications regarding your claims submission.
9. Complete the 'Primary Practice Address' fields, including address lines, city, state, and zip code.
10. Add 'Office Phone' and 'Office Fax' numbers to facilitate contact.
11. In the 'Billing Information' section, provide 'Billing Name', 'Address', 'City', 'State', 'Billing Contact', and 'TAX ID'.
12. Fill out any additional comments in the 'Comments' section as needed.
13. Attach a copy of the W-9 form as required.
14. Review all entries for accuracy, and when finished, save changes, download, print, or share the completed form as needed.

Complete your Bmc Pdffilter online today and ensure timely processing of your claims.