Get Generations Claim Reconsideration Request Form - Generationshealthcare

Completing the Generations Claim Reconsideration Request Form is essential for healthcare professionals seeking to appeal denied claims for members enrolled in a Medicare benefit plan. This guide provides clear, step-by-step instructions to assist users in filling out the form accurately and efficiently.

Follow the steps to complete your claim reconsideration request.

1. Click ‘Get Form’ button to access the Generations Claim Reconsideration Request Form.
2. Fill out the mailing address for the request. Write 'PO Box 1747 OKC, OK 73101 Attn: Claim Reconsiderations'.
3. Indicate your status by selecting one of the following options: Physician, Hospital, or Other health care professional.
4. Enter the date when the form is completed in the designated field.
5. Provide the member information, including the Member ID, Claim Number, Date of Service, and Billed Charges.
6. Input the Member's Name and Date of Birth. If the Patient Name differs, fill in the Patient's Name and Date of Birth as well.
7. Complete the Physician or health care professional information section. This includes filling in your name, Tax Identification Number (TIN), contact name, email, phone, and fax.
8. In the Reason for Request section, specify the reason for the claim reconsideration. Check appropriate boxes and provide any necessary attachments or explanations.
9. Ensure all information is accurate and complete. Review the request for any missing information or potential errors.
10. Save your changes. You may then have the option to download, print, or share the completed form for submission.

Complete your Generations Claim Reconsideration Request Form online to ensure a prompt resolution.