Get Nas Reimbursement Form

Filling out the Nas Reimbursement Form online is an essential step for users seeking to claim medical expenses. This guide will walk you through each section of the form, providing clear instructions to ensure a smooth and accurate completion.

Follow the steps to successfully complete your form.

1. Click ‘Get Form’ button to access the Nas Reimbursement Form and open it for editing.
2. In Section 1, provide the member information. Fill in the patient's name as it appears on their card and the associated patient card number. Also, include the patient's date of birth, the principal’s name, and their contact information, which consists of an email address and a mobile number.
3. In Section 2, ensure the medical information is fully completed by the patient's medical practitioner. This includes details like the country of treatment, provider's name and contact, the date when the first symptoms were noticed, and the physician's name and contact information. The medical practitioner must sign and stamp the form and provide the date. Be sure to include information about the diagnosis, symptoms, and any treatments or investigations undertaken.
4. In Section 3, enter the claimed invoices. List each invoice number, claimed amount, and currency for each item. Make sure to detail all the invoices provided to ensure accurate claims.
5. In Section 4, fill in the settlement details. Select the settlement currency, and provide the bank name, account title, IBAN number or account number, SWIFT code, bank address, and beneficiary address. Choose between cheque or wire transfer for the settlement method. Confirm that bank details are entered in block letters.
6. After filling out all sections, review the entire form for any missing information. Save any changes, and ensure to download, print, or share the form as needed for your records or submission.

Complete your Nas Reimbursement Form online today and ensure your medical claims are processed efficiently.