Get Medicare Advantage Member Application For Payment ... - Bcbsm.com

Completing the Medicare Advantage Member Application For Payment is a straightforward process that ensures your medical expenses receive the consideration they deserve. This guide will provide you with step-by-step instructions to help you fill out the application accurately and efficiently.

Follow the steps to fill out your application for payment consideration.

1. Press the ‘Get Form’ button to access the application form online, allowing you to fill it out digitally.
2. Begin with the member information section, entering the member's last name, first name, and alphanumeric contract number exactly as they appear on the BCBSM ID card.
3. Input the member's street address, city, state, and zip code to ensure proper identification and processing.
4. Provide the member's date of birth and sex, selecting from the options provided.
5. Indicate whether the medical issue was work-related by selecting ‘Yes’ or ‘No.’ Similarly, state if it was related to an auto accident.
6. If applicable, enter the date of injury or illness to provide context to the claim.
7. Fill in the details of any other health insurance the member may have, including the name of the insurance company and policy number if relevant.
8. Review all entered information for accuracy and completeness. Signature and date fields are required; the member must certify the truthfulness of the information provided.
9. Upon completion, save your changes. You can download the application, print it out for submission, and ensure to mail it along with original receipts to the specified address.

Start completing your Medicare Advantage Member Application online today!