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General Fax Authorization Request Medical Management Fax 18002415308 Member/Subscriber Information: ID No.: Last Name: First Name: Patient Information: Last Name: First Name: Relationship to Member/Subscriber:.

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How and when can I contact my health plan? Blue Cross NC's Customer Service representatives are available to answer calls at 1-877-258-3334, Monday through Friday from 8:00 a.m. to 7:00 p.m.

Your doctor must contact SMS at 1-855-243-3326. You can also check the status of your authorization by contacting the phone number on the back of your ID card.

Plan from seeking additional information or documents from Provider in relation to its review of other requests or matters. 10. Fax each completed Predetermination Request Form to 800-852-1360. If unable to fax, you may mail your request to BCBSIL, PO BOX 805107, Chicago, IL, 60680-3625.

Fax: (916) 350-8860, Monday - Friday, 6:00 a.m. - 6:30 p.m.

Including home health care services, durable medical equipment, behavioral health (mental health/substance use disorder) and the Prior Review List. The Avalon portal will not be available until 4/23. Please fax the completed form to Avalon's Medical Management Department at 813-751-3760.

If 150 to 300 pages: Fax the cover sheet followed by the medical record to 1-919-765-3204.

This document is intended to clarify submission requirements to Blue Cross and Blue Shield of Minnesota and Blue Plus (Blue Cross) for proper handling. The proper fax number for claims attachments is 1-800-793-6928.

Your payer name is Healthy Blue North Carolina, and the payer ID is 00602.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232