Get Bcbs 26240 - Wdop Form 06182014

Filling out the BCBS 26240 - WDOP Form is essential for directing benefit payments to a non-network provider. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to successfully fill out the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor for editing.
2. Fill in the insured’s name in the designated field. This is the individual whose insurance benefits are being directed.
3. Enter the insured’s Blue Cross & Blue Shield of Mississippi identification number. This unique number is essential for processing the benefits correctly.
4. Specify the non-network provider’s name in the corresponding section. Ensure this information matches the details on their documentation.
5. Complete the tax ID field of the non-network provider. This number is crucial for tax reporting purposes.
6. Input the non-network provider’s National Provider Identifier (NPI) in the appropriate space to identify their services accurately.
7. Indicate the benefit assignment effective date. This is the date when the direction of payment begins.
8. If applicable, provide the benefit assignment end date. This marks when the written direction of payment will no longer be valid, unless revoked earlier by the insured.
9. Review all information for accuracy. Ensure that all fields are completed correctly before proceeding.
10. Sign the form. The insured’s signature indicates their consent and understanding of the payment direction.
11. Enter the date of signing in the designated area to confirm when the document was completed.
12. Once all entries are complete, save the changes, download, print, or share the form as instructed.

Complete your form online today to ensure timely processing of your benefit payments.