Get Medical Claim Form Pdf - Apwu Health Plan

Filling out the Medical Claim Form PDF for the APWU Health Plan is essential for users seeking reimbursement for medical services. This guide provides clear, step-by-step instructions tailored to assist all users in completing the form accurately and efficiently.

Follow the steps to complete your Medical Claim Form online.

1. Click 'Get Form' button to access the Medical Claim Form PDF and open it in your preferred editor.
2. Complete the top half of the form with your personal information, including your name, contact information, and any pertinent identification numbers.
3. In the 'Insured's or Authorized Person's Signature' section (Block 13), sign and date the form if you want your APWU Health Plan to pay your healthcare provider directly. Do not sign if you wish to receive the payment yourself.
4. Attach an itemized bill to your claim submission. Ensure that the bill clearly outlines the services rendered. Avoid using cancelled checks or cash register receipts as they are not acceptable.
5. If you have coverage under Medicare or another group insurance plan, include a payment or denial statement from that carrier with your claim. Failure to do so may result in rejection.
6. Ensure your claim is submitted by December 31 of the year following the year you received the service. Claims submitted after this date will be invalidated.
7. For the bottom half of the form (Items 14-33), the healthcare provider must complete the required information, including their Federal Tax ID number and valid National Provider Identifier (NPI).
8. Once the form is fully completed, save all changes, then you can download, print, or share the form as needed.

Get started by completing your Medical Claim Form PDF online today.