Get Over-the-counter (otc) Items Claim Form - Wellcare

Filing a claim for eligible over-the-counter items can be a straightforward process when you understand how to fill out the WellCare OTC Items Claim Form. This guide will walk you through each step to ensure that your claim is completed accurately and submitted for reimbursement.

Follow the steps to fill out the OTC Items Claim Form online.

1. Press the ‘Get Form’ button to obtain the OTC Items Claim Form and open it in your preferred editor.
2. Begin filling out the form by entering the member's name in the designated field.
3. Input the member ID in the corresponding section of the form.
4. Provide the address of the member. If the address has changed, check the box indicating a new address.
5. Fill in the city, state, and ZIP code.
6. Enter a telephone number where the member can be reached.
7. List the purchase date of each item on the claim in the appropriate field.
8. Specify the merchant's name and ZIP code where the items were purchased.
9. In the item name/description field, provide clear descriptions of each item, including package size and total item cost.
10. For each item, calculate the total cost, including any applicable taxes, and ensure it is noted correctly on the form.
11. If there are multiple counts of the same item, use a new line for each count, ensuring all items are listed.
12. Calculate the grand total for all items and enter it in the grand total field.
13. The member must sign and date the form at the bottom to certify the accuracy of the information.
14. Once completed, save any changes made to the document, and choose to download, print, or share the form as needed.

Start filling out your OTC claim form online today to ensure quick reimbursement!