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Pain Management Prior Authorization Request Form 52274 Please fax to OrthoNet at: 18667470587 Fax Date: # of Pages Faxed: PATIENT INFORMATION First Name Alpha Prefix BCBST Member ID Number Suffix.

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Prior authorization (PA) may be required via BCBSTX's medical management, eviCore® healthcare, Carelon Medical Benefits Management effective March 1, 2023 (formerly AIM) or Magellan Healthcare®. You can review how to submit PA or Notification requests and view PA statistical data here.

Prior Authorization Information Prior authorization is required for certain procedures, services and medications, as well as for all inpatient admissions.

Claims Submission 220 Burnham St S Windsor CT 06074 Claims Proc Svc dba Emdeon Dental Page 4 BCBST's Secure File Gateway (SFG) allows trading partners to submit electronic claims and download electronic reports using multiple secure managed file transfer protocols.

From the Smoky Mountains to the Mississippi River, our provider network covers all 95 counties of the state and beyond.

Phone 1-800-292-8196. 1-800-292-8196. TRS users should call: 711 (Ask for 888-418-0008) TRS users should call: 711 (Ask for 888-418-0008) EMAIL US.

You can verify benefits and request prior authorization at Availity.com or by phone at 1-888-693-32111-888-693-3211 or by fax at 1-888-693-3210.

Submitting Claims Please continue to use EDI claims submission. BlueCross BlueShield of Tennessee payer ID number: 00390.

If you receive a denial for Reconsideration or an Expedited Appeal, you can submit a Standard Appeal within 60 days.

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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