Get Section 1 About Bluecross Blueshield - Bluecross Blueshield Of ...

Filling out the Section 1 About BlueCross BlueShield form is a crucial step in ensuring that all relevant information is accurately reported. This guide will provide clear, step-by-step instructions to help you complete the form online efficiently.

Follow the steps to effectively complete the form.

1. Click ‘Get Form’ button to begin the process of obtaining the form and access it for completion.
2. Indicate the type of form you are submitting by selecting from the options: initial form, additional form, or revised form. If applicable, enter the date revised.
3. Select whether the patient is a FEP member or a non-FEP member.
4. Fill in the patient's name, ID number, and date of birth. Ensure accuracy when entering these details.
5. Specify the referring plan or FEP servicing plan and the transplant center.
6. Provide the patient account number and solid organ type, selecting from the available options: initial transplant, re-transplant, deceased donor, or living donor.
7. Complete the diagnosis section by entering the appropriate DRG/ICD10 codes.
8. In the global period section, enter the relevant dates and charges for the pre-transplant period, including hospital and professional charges.
9. If applicable, fill in the information for the global rate and amounts due, including any adjustments related to prior payments.
10. Specify who completed the form by printing their name, entering their email address, phone number, and the date of entry.
11. Submit the completed form along with all claims to the specified BlueCross BlueShield address.

Complete the document and submit it online to ensure timely processing.