Get Foreign / Overseas Claim Form As A Member Of The Compass ...

This guide provides clear instructions on how to effectively complete the FOREIGN / OVERSEAS Claim Form as a member of the Compass Rose Health Plan online. Following these steps will help ensure that your claims are submitted accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Click the ‘Get Form’ button to obtain the claim form and open it in your preferred editor.
2. Fill in your personal information, including your name as the primary member, health plan member ID number, patient’s name, date of birth, address, city, state, zip code, and phone number.
3. Indicate whether the claim is related to an accident by selecting 'Yes' or 'No'. If 'Yes', provide additional details such as the date of the accident, whether it was work-related, and a description of the accident's location.
4. List the charges being claimed. Include the name of the provider, type of provider, description of service, date of service, and charge of service in local currency. Ensure that you attach itemized bills and receipts for all services claimed. Add a separate sheet of paper if more space is needed.
5. For any foreign language documents, identify the country and specify the language used, as translation is required for reimbursement.
6. If submitting prescription claims, ensure to provide a copy of the drug receipt, detailing the pharmacy name, drug details, Rx number, and purchase date.
7. Fill out the necessary banking information for direct deposit, including the name on the bank account, bank routing number (ensure it is a 9-digit number starting with 0, 1, 2, or 3), bank name, and account number.
8. Choose whether the payment should go into a checking or savings account and ensure all details are accurate.
9. Sign and date the form in the designated area to authenticate the claim.
10. Save any changes you made to the form. You can then choose to download, print, or share the completed form as necessary.

Complete and submit your claims online to ensure efficient processing and reimbursement.