Get Member Application For Payment Consideration - Bcbsmcom

Completing the Member Application For Payment Consideration form is an important step for users seeking reimbursement for medical expenses through Blue Cross Blue Shield of Michigan. This guide provides clear, step-by-step instructions on how to accurately fill out the form to ensure a smooth submission process.

Follow the steps to complete your application effectively.

1. Click ‘Get Form’ button to access the application and open it for completion.
2. Enter the subscriber's alpha/numeric contract number as found on your BCBSM identification card. This is essential for linking the claim to the correct policy.
3. Fill in the subscriber's personal information, including first name, last name, and complete street address. Ensure that the details are accurate to avoid processing delays.
4. Provide the city, state, and zip code of the subscriber's address.
5. Under the patient information section, input the patient's first name, date of birth, and indicate if the patient’s medical issue was related to an auto accident or work.
6. If applicable, fill in the Medicare HIB number and specify the sex of the patient.
7. Record the admission date and discharge date of the patient's visit as it relates to their treatment.
8. If there is other health insurance involved, provide the name of the insurance company and the policy number.
9. Before finalizing the form, review all entries for accuracy. Once confirmed, sign and date the form after printing it out.
10. Gather and attach original receipts related to the claim. Ensure they meet the specified requirements for processing, including proper formatting and necessary details.
11. Make copies of all submitted materials for your records before mailing the original receipts and completed form to the address provided.

Start filling out your Member Application For Payment Consideration form online today to ensure timely processing of your claims.