Get State Of Maryland Health/vision Plan Claim Form - Smcm

Completing the State Of Maryland Health/Vision Plan Claim Form - Smcm online can simplify the process of filing for health and vision benefits. This guide offers a step-by-step approach to ensure all necessary information is provided accurately.

Follow the steps to successfully complete the claim form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the top section, enter the subscriber’s legal name along with the patient’s legal name. Fill in the membership number and select the patient’s sex. Provide the patient’s date of birth, address, and indicate if there is a new address by checking the appropriate box.
3. Continue by detailing the patient's relationship to the subscriber. Choose from options such as 'Self', 'Spouse', 'Child', or 'Other'.
4. Next, list the illnesses for which you are submitting claims, including the date of the first symptom. For routine vision claims, only the date of service is needed.
5. Indicate whether the treatment was the result of an injury or automobile accident, and if the injury was work-related. Provide details such as the description of the accident and the date it occurred.
6. Complete the section regarding Medicare coverage. Specify if the patient has Medicare Part A and/or Part B, along with effective dates of coverage.
7. If the patient is covered under another insurance policy, fill in the necessary details regarding the policy holder, insuring company, and the type of coverage.
8. At the bottom of the form, confirm that all information is complete and accurate by providing the subscriber's signature and the date. Ensure you have attached the itemized bills required for processing.
9. Finally, users can save changes, download, print, or share the form as needed.

Start filing your claims online today for a smoother healthcare experience.