Get Mi Bcbs Wf 3861 2013-2025

Filling out the MI BCBS WF 3861 form online can be a straightforward process when you follow the right steps. This guide will walk you through each section of the form to ensure that you provide all necessary information accurately.

Follow the steps to complete the MI BCBS WF 3861 form online.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by entering the subscriber's alpha/numeric contract number, which can be found on your BCBSM I.D. card. This is crucial for identifying your account.
3. Fill in the member information section with the subscriber's first and last name, street address, city, state, and zip code.
4. In the patient information section, enter the patient's first name, sex, date of birth, and address. If applicable, indicate whether the incident was related to an auto accident or was work-related, and provide the admission and discharge dates.
5. If the patient has other health insurance, provide the name and policy number of the insurance company. Also, make sure to include the Medicare HIB number if available and the Medicare Summary Notice for processing.
6. Review the certification statement and ensure that you understand that the information provided is accurate and that all submitted materials are the property of Blue Cross Blue Shield of Michigan.
7. Print the form and sign it in the designated area. Make sure to do this after completing the online form.
8. Gather original receipts and any additional documents required, such as the Explanation of Benefits statements, and attach them to the completed form.
9. Finally, save any changes made to the form, download a copy for your records, and prepare to mail the original form and documents to the appropriate address provided in the instructions.

Complete the MI BCBS WF 3861 form online today to ensure your claims are processed efficiently.