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  • Member Submitted Claim Form - Lifewise Health Plan Of Washington

Get Member Submitted Claim Form - Lifewise Health Plan Of Washington

1 Members Information: First Name: Last Name:Information Release FormFollow the steps to authorize LifeWise Health Plan of Washington Date of Birth: MM/DD/YY (LifeWise) to release your protected health.

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LifeWise, a Premera affiliate, has marketplace plans available in 35 counties throughout Washington state. Group/Commercial: These can be PPO or EPO and are typically employer-based plans. Examples of EPO plans are Peak Care and Your Focus, while Your Choice and Your Future are PPO.

Call 800-435-2715 if you have questions about our electronic claims clearinghouse. To submit claims electronically, use 91049 as the payer ID.

What if I need to cancel my plan? If you purchased your plan directly from LifeWise, you can call customer service at 800-817-3056. If you purchased your plan from Washington Healthplanfinder, please call their customer support at 855-923-4633. You cannot cancel your plan by calling LifeWise customer service.

To report web issues, email us, or call 800-817-3056.

Claim payer IDs by category for Premera PlanProfessionalInstitutionalPremera Blue Cross*0043000430

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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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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